Updated on 2025/05/09

Information

 

写真a

 
ISHIGAMI KOSEI
 
Organization
Faculty of Medical Sciences Department of Clinical Medicine Professor
Kyushu University Hospital Radiology Center(Concurrent)
Kyushu University Hospital Radiology(Concurrent)
School of Medicine Department of Medicine(Concurrent)
Graduate School of Medical Sciences Department of Medicine(Concurrent)
Graduate School of Medical Sciences Department of Medical Sciences(Concurrent)
Title
Professor
Contact information
メールアドレス
Tel
0926425690
Profile
Abdominal imaging Pancreas and biliary imaging Pancreatic tumors Radiological anatomy Renal tumors
Homepage
External link

Research Areas

  • Life Science / Radiological sciences

Degree

  • M.D., Ph.D.

Research History

  • 琉球大学 放射線診断治療学講座   

Research Interests・Research Keywords

  • Research theme: Abdominal Imaging

    Keyword: Pancreas, Hepatobiliary, GI, GU

    Research period: 2020.4 - 2032.3

  • Research theme: Radiological diagnosis of the pancreatic diseases

    Keyword: pancreas, CT, MRI, pancreatic masses

    Research period: 2014.7 - 2018.3

  • Research theme: Cross sectional abdomino-pelvic imaging

    Keyword: Pancreatic tumors, Liver tumors, Differential diagnosis, Clinical application of diagnostic imaging

    Research period: 2009.5 - 2009.12

Awards

  • Krabbenhoft Award for Excellence in Teaching

    2014.6   Iowa大学   Iowa大学放射線科のFaculty Awardのなかで最も栄誉ある賞とされる

  • Faculty Teacher of the Year

    2013.6   University of Iowa   Iowa大学放射線科におけるレジデント教育への貢献が最も高かった者に与えられる賞で、レジデントの投票によって1名の受賞者が決定される。

  • Cypos賞 Silver Medal

    2012.4   第71回日本医学放射線学会総会  

  • CyPos賞 Gold Medal

    2011.5   第70回日本医学放射線学会総会  

  • 打田賞

    2009.6   腹部放射線研究会   膵管内管状腫瘍の画像所見

  • 日本医学放射線学会研究助成

    2008.4   日本医学放射線学会  

  • 板井研究奨励賞

    2007.4   第66回 日本医学放射線学会  

  • 板井悠二賞

    2007.1   第13回 肝血流動態イメージ研究会  

  • Certificate of Merit

    2006.11   北米放射線学会(RSNA)  

  • 教育展示優秀賞

    2006.4   第65回日本医学放射線学会  

  • Special Award for Outstanding Clinical Service

    2003.6   University of Iowa, Carver College of Medicine  

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Papers

  • Mucinous nonneoplastic cyst of the pancreas: CT and MRI appearances. Reviewed International journal

    Ishigami K, Akihiro Nishie, Mochidome N, Asayama Y, Ushijima Y, Kakihara D, Okamoto D, Fujita N, Ohtsuka T, Miyasaka Y, Hida T, Yoshizumi T, Honda H

    Abdom Radiol (NY). 2017 May 31.   2017.5

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  • Imaging spectrum of renal oncocytomas: a pictorial review with pathologic correlation. Reviewed International journal

    Ishigami K, Jones AR, Dahmoush L, Leite LV, Pakalniskis MG, Barloon TJ

    Insights Imaging. 2015 Feb;6(1):53-64.   6 ( 1 )   53 - 64   2015.2

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  • Characterization of renal cell carcinoma, oncocytoma, and lipid-poor angiomyolipoma by unenhanced, nephrographic, and delayed phase contrast-enhanced computed tomography. Reviewed International journal

    Ishigami K, Pakalniskis MG, Leite LV, Lee DK, Holanda DG, Rajput M

    Clin Imaging. 2015 Jan-Feb;39(1):76-84.   39 ( 1 )   76 - 84   2015.1

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  • Tumor grade of clear cell renal cell carcinoma assessed by contrast-enhanced computed tomography. Reviewed International journal

    Ishigami K, Leite LV, Pakalniskis MG, Lee DK, Holanda DG, Kuehn DM

    Springerplus. 2014 Nov 26;3:694. doi: 10.1186/2193-1801-3-694.   3   694   2014.11

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  • Radiologic manifestations of angioedema. Reviewed International journal

    Ishigami K, Averill SL, Pollard JH, McDonald JM, Sato Y

    Insights ingto imaging   5 ( 3 )   365 - 374   2014.6

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  • Comparison of 2 oral ultrasonography contrast agents: simethicone-coated cellulose and simethicone-water rotation in improving pancreatic visualization. Reviewed International journal

    Ishigami K, Abu-Yousef DM, Kao SCS, Abu-Yousef MM

    Ultrasound Q. 2014 Jun;30(2):135-8.   30 ( 2 )   135 - 138   2014.6

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  • Imaging pitfalls of pancreatic serous cystic neoplasm and its potential mimickers Invited Reviewed International journal

    Ishigami K, Akihiro Nishie, Asayama Yoshiki, Yasuhiro Ushijima, Yukihisa Takayama, Fujita Nobuhiro, Shunichi Takahata, Ohtsuka Takao, Tetsuhide Ito, Hisato Igarashi, Ikari S, Metz CM, Hiroshi Honda

    World J Radiol 2014; 6(3): 36-47.   6 ( 3 )   36 - 74   2014.3

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  • The prevalence of circumportal pancreas as shown by multidetector-row computed tomography Reviewed International journal

    Ishigami K, Tajima T, Nishie A, Asayama Y, Kakihara D, Nakayama T, Shirabe K, Taketomi A, Nakamura M, Takahata S, Ito T, Honda H

    Insights into Imaging   2011.4

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  • Hepatocellular carcinoma with marginal superparamagnetic iron oxide uptake on T2*-weighted magnetic resonance imaging: Histopathologic correlation. Reviewed International journal

    Ishigami K, Tajima T, Fujita N, Nishie A, Asayama Y, Kakihara D, Nakayama T, Okamoto D, Taketomi A, Shirabe K, Honda H.

    Eur J Radiol.   2011.1

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  • Spectrum of Unusual Imaging Findings of Metastatic Lesions from Gastric Cancer Reviewed International journal

    Ishigami K, Yoshimitsu K, Irie H, Tajima T, Nishie A, Hirakawa M, Ushijima Y, Okamoto D, Ino A, Kiyosawa E, Sakai M, Hirata A, Honda H

    Current Medical Imaging Reviews   6 ( 3 )   2010.8

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  • Differential diagnosis of groove pancreatic carcinomas vs. groove pancreatitis: Usefulness of the portal venous phase. International journal

    Ishigami K, Tajima T, Nishie A, Kakihara D, Fujita N, Asayama Y, Ushijima Y, Irie H, Nakamura M, Takahata S, Ito T, Honda H.

    Eur J Radiol.   74 ( 3 )   2010.6

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  • MRI findings of pancreatic lymphoma and autoimmune pancreatitis: A comparative study. Reviewed International journal

    Ishigami K, Tajima T, Nishie A, Ushijima Y, Fujita N, Asayama Y, Kakihara D, Irie H, Ito T, Igarashi H, Nakamura M, Honda H.

    Eur J Radiol.   74 ( 3 )   2010.6

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  • Hepatocellular Carcinoma with MRI Pseudocapsule: Correlation of Gadolinium Enhanced MR Imaging and Histopathology Reviewed International journal

    Ishigami K, Yoshimitsu K, Nishihara Y, Irie H, Asayama Y, Tajima T, Nishie A, Hirakawa M, Ushijima Y, Okamoto D, Taketomi A, Honda H.

    Radiology   2009.2

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  • Diagnostic value of the delayed phase image for iso-attenuating pancreatic carcinomas in the pancreatic parenchymal phase on multidetector computed tomography. Reviewed International journal

    Ishigami K, Yoshimitsu K, Irie H, Tajima T, Asayama Y, Nishie A, Hirakawa M, Ushijima Y, Okamoto D, Nagata S, Nishihara Y, Yamaguchi K, Taketomi A, Honda H.

    Eur J Radiol.   2009.1

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  • Imaging of Intraductal Tubular Tumors of the Pancreas. Reviewed International journal

    Ishigami K, Yoshimitsu K, Irie H, Shinozaki K, Nagata S, Yamaguchi K, Honda H.

    AJR Am J Roentgenol.   2008.12

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  • Lesions Arising in or Involving the Iliopsoas Groove. Reviewed International journal

    Ishigami K, Yoshimitsu K, Irie H, Tajima T, Asayama Y, Nishie A, Hirakawa M, Ushijima Y, Okamoto D, Honda H.

    J Comput Assist Tomogr.   2008.12

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  • Significance of Perivascular Softtissue around the Common Hepatic and Proximal Superior Mesenteric Arteries Arising after Pancreaticoduoodenectomy:Evaluation with Serial MDCT Studies. Reviewed International journal

    Ishigami K, Yoshimitsu K, Irie H, Tajima T, Asayama Y, Hirakawa M, Kakihara D, Shioyama Y, Nishihara Y, Yamaguchi K, Honda H

    Abdom Imaging.   2008.11

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  • Significance of Mesenteric Lymphadenopathy after Pancreaticoduodenectomy for Periampullary Carcinomas: Evaluation with Serial MDCT Studies. Reviewed International journal

    Ishigami K, Yoshimitsu K, Irie H, Tajima T, Asayama Y, Hirakawa M, Kakihara D, Shioyama Y, Nishihara Y, Yamaguchi K, Honda H.

    Eur J Radiol.   2007.3

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  • Accessory left gastric artery from left hepatic artery shown on MDCT and conventional angiography: correlation with CT hepatic arteriography. Reviewed International journal

    Ishigami K, Yoshimitsu K, Irie H, Tajima T, Asayama Y, Hirakawa M, Honda H.

    AJR Am J Roentgenol.   2006.10

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  • Tubular Ectasia of the Epididymis: A Sign of Postvasectomy Status. Reviewed International journal

    Ishigami K, Abu-Yousef MM, Yousef EZ.

    J Clin Urtrasound.   2005.12

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  • Diagnostic value of gadolinium-enhanced 3D magnetic resonance angiography in patients with Suspected hepatic arterial complications after liver transplantation. Reviewed International journal

    Ishigami K, Stolpen AH, Al-Kass FM, Zhang Y, Rayhill SC, Katz DA, Abu-Yousef M.

    J Comput Assist Tomogr.   2005.7

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  • Does Variant Hepatic Artery Anatomy in a Liver Transplant Recipient Increase the Risk of Hepatic Artery Complications After Transplantation? Reviewed International journal

    Ishigami K, Zhang Y, Rayhill SC, Katz DA, Stolpen AH.

    AJR Am J Roentgenol.   2004.12

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  • Enlargement and Hypervascularity of Both the Epididymis and Testis Do Not Exclude Involvement with Lymphoma or Leukemia. Reviewed International journal

    Ishigami K, Yousef-Zahra DM, Abu-Yousef MM.

    J Clin Urtrasound.   2004.9

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  • Multi-delay arterial spin labeling using a variable repetition time scheme in Moyamoya disease: Comparison with single-delay arterial spin labeling

    Mikayama, R; Togao, O; Obara, M; Wada, T; Tokunaga, C; Yoshidome, S; Kato, T; Isoda, T; Ishigami, K; Yabuuchi, H

    EUROPEAN JOURNAL OF RADIOLOGY   186   112034   2025.5   ISSN:0720-048X eISSN:1872-7727

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    Purpose: To present a multi-delay arterial spin labeling (ASL) protocol that obtains the cerebral blood flow (CBF) considering the arterial transit time (ATT), and to assess the correlations with an iodine-123-N-isopropyl-p-iodoamphetamine single-photon emission computed tomography (123I-IMP SPECT) reference standard between multi-delay ASL and single-delay ASL in patients with Moyamoya disease. Method: We retrospectively analyzed the images of 23 patients with Moyamoya disease (4–73 years, 5 men, 18 women), each of whom was imaged with 10-delay ASL using the variable repetition time (TR) scheme, single-delay ASL, and SPECT. Pearson correlation coefficients were calculated between the CBF values of each ASL and SPECT in the three divisions of the ATT, which we categorized as fast, normal, and slow regions. The threshold for statistical significance was set at P < 0.05. Results: The CBF measured by multi-delay ASL and single-delay ASL were positively correlated with that measured by SPECT, with correlation coefficients of 0.6701 and 0.5637, respectively (P < 0.001). In the fast, normal, and slow ATT divisions, the correlation coefficients between the CBF measured by multi-delay ASL and that measured by SPECT were 0.6745, 0.7055, and 0.6746, respectively. Similarly, the correlations between the CBF measured by single-delay ASL and that measured by SPECT were 0.3811, 0.5090 and 0.6178, respectively. Conclusions: Multi-delay ASL using the variable TR scheme showed a higher correlation with 123I-IMP SPECT than single-delay ASL for measuring the CBF. The variable TR scheme potentially improved the quantification of CBF on ASL imaging.

    DOI: 10.1016/j.ejrad.2025.112034

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  • Optimization of shoulder synthetic MRI through post-processing and comparison with conventional MRI

    Nishizawa, N; Yabuuchi, H; Nishikawa, K; Wada, T; Kobayashi, K; Tokunaga, C; Kojima, T; Ohnishi, T; Yano, Y; Sagiyama, K; Hida, T; Yamasaki, Y; Hino, T; Ishigami, K

    EUROPEAN JOURNAL OF RADIOLOGY   186   112069   2025.5   ISSN:0720-048X eISSN:1872-7727

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    Purpose: To evaluate the utility of synthetic MRI of the shoulder compared with conventional MRI and to optimize the parameters of morphological images through post-processing. Additionally, we aimed to assess the agreement of T2 values between multi-echo spin-echo (MESE) and multi-dynamic multi-echo (MDME) sequences. Methods: Twenty healthy volunteers underwent shoulder MRI. The optimal post-processing parameters for the tendon–muscle contrast were examined using synthetic MRI, and two radiologists analyzed three image sets: conventional images, synthetic images using preset parameters, and optimized images. Qualitative analysis included assessment of the visibility of anatomical structures, overall image quality, and magic angle effect, whereas the quantitative analysis included measurement of the relative signal intensity and relative contrast. The T2 values of the articular cartilage and supraspinatus muscle were measured for each sequence. Results: Images synthesized with short echo times and long repetition times showed high tendon–muscle contrast. For fat-suppressed T2-weighted images, conventional images showed the highest image quality (p < 0.001), whereas the optimized images achieved comparable visibility of the rotator cuff (p = 0.031–1.0). No significant differences were observed among image sets in proton density-weighted images and T1-weighted images (p > 0.05). The T2 values of the MDME sequence were consistent with those of the MESE sequence at the muscle (p = 0.81), but were approximately 8.3 ms longer at the cartilage (p < 0.001). Conclusions: Synthetic MRI provided acceptable image quality using appropriate post-processing parameters. The simultaneous acquisition of multiple morphological images and quantitative maps within five minutes holds promise for shoulder examination.

    DOI: 10.1016/j.ejrad.2025.112069

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  • Explainable radiomics based on association of histopathological cell density and multiparametric MR radiomic features for high-risk stratification of prostate cancer patients.

    Shibayama Y, Arimura H, Takayama Y, Kinoshita F, Takamatsu D, Nishie A, Kobayashi S, Matsumoto T, Shiota M, Eto M, Oda Y, Ishigami K

    Magma (New York, N.Y.)   2025.4   ISSN:0968-5243

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    DOI: 10.1007/s10334-025-01250-6

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  • Integration of amide proton transfer-weighted imaging and methionine positron emission tomography histogram parameters enhances the prediction of isocitrate dehydrogenase mutations in adult diffuse gliomas

    Kusunoki, M; Isoda, T; Yamashita, K; Kitamura, Y; Kikuchi, K; Sando, M; Baba, S; Kuga, D; Fujioka, Y; Narutomi, F; Yoshimoto, K; Ishigami, K; Togao, O

    EJNMMI REPORTS   9 ( 1 )   13   2025.4   eISSN:3005-074X

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    Background: To evaluate whether the combination of amide proton transfer-weighted imaging (APT-WI) and methionine positron emission tomography (MET-PET) enhances the non-invasive prediction of isocitrate dehydrogenase (IDH) mutation status in adult diffuse gliomas. Results: We retrospectively analysed 28 adult patients with histologically confirmed diffuse gliomas who underwent preoperative APT-WI and MET-PET imaging at our institution. Histogram analyses were conducted for both imaging modalities, extracting parameters such as the 10th, 50th, 70th, and 90th percentiles, mean, variance, skewness, and kurtosis. Parameters between IDH-mutant and IDH-wildtype gliomas were compared using the Mann–Whitney U test. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis, and combined models of the two parameters were constructed using multivariable logistic regression. IDH-wildtype gliomas exhibited significantly higher APT-WI 90th percentile (APT90) values (median: 3.51%, interquartile range [IQR]: 1.92–4.23%) compared to IDH-mutant gliomas (median: 2.24%, IQR: 1.52–2.85%, p = 0.039). Similarly, IDH-wildtype gliomas showed elevated MET-PET maximum tumour-to-normal ratios (TNRmax) (median: 2.51, IQR: 2.13–3.41) compared to IDH-mutant gliomas (median: 1.62, IQR: 1.30–2.77, p = 0.020). ROC curve analysis indicated that the combined model of APT90 and TNR kurtosis achieved an area under the curve of 0.85, demonstrating superior diagnostic accuracy compared to that of single-parameter models. Conclusions: Combining histogram-derived parameters from APT-WI and MET-PET significantly improves the diagnostic accuracy for predicting IDH mutation status in diffuse gliomas. This non-invasive approach may serve as a valuable adjunct for preoperative evaluation and the development of personalised treatment strategies in patients with gliomas.

    DOI: 10.1186/s41824-025-00248-6

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  • Programmed Cell Death 10<i> (PDCD10</i>) Is a Candidate Tumor-associated Gene in Esophageal Squamous Cell Carcinoma

    Hiraki, Y; Masuda, T; Motomura, Y; Tobo, T; Saito, H; Hirose, K; Ofuchi, T; Tsuda, Y; Otsu, H; Yonemura, Y; Kai, S; Hirakawa, M; Ishigami, K; Mimori, K

    ANTICANCER RESEARCH   45 ( 4 )   1419 - 1433   2025.4   ISSN:0250-7005 eISSN:1791-7530

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    Background/Aim: Esophageal squamous cell carcinoma (ESCC) is a highly aggressive malignancy with poor survival rates. Effective molecular-targeted therapies are urgently needed. This study aimed to identify novel candidate tumor-associated genes in ESCC by analyzing chromosomal amplification regions. Materials and Methods: DNA copy number variation (CNV) and mRNA expression data were obtained from The Cancer Genome Atlas (TCGA) and Cancer Cell Line Encyclopedia (CCLE). Single-cell RNA sequencing data from Gene Expression Omnibus (GEO) were analyzed using Scanpy. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded (FFPE) ESCC tissues. PDCD10 was identified as a potential tumor-associated gene, and its association with clinicopathological factors and prognostic impact was evaluated using Kaplan-Meier survival and Cox regression analyses. Pathway analysis was performed to investigate the biological processes, and drug sensitivity profiling was conducted to identify compounds whose efficacy correlated with PDCD10 expression in ESCC cell lines. Results: PDCD10, a signaling protein involved in cell proliferation and vascular development, showed significant amplification and over-expression in ESCC cases. High PDCD10 expression was associated with poor prognosis. Single-cell RNA sequencing confirmed its tumor-specific expression. GSEA revealed enrichment of mTORC1 signaling, E2F, and Myc target pathways in high PDCD10-expressing tumors. Drug sensitivity analysis identified Azelaic acid and Rebamipide as compounds whose efficacy correlated with PDCD10 expression in ESCC cell lines. Conclusion: PDCD10 could be a novel tumor-associated gene associated with tumor progression and poor prognosis in ESCC. Azelaic acid and Rebamipide are candidate therapeutic agents targeting PDCD10.

    DOI: 10.21873/anticanres.17527

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  • Clinical utility of non-gated 4-min delayed dual-energy CT for myocardial extracellular volume quantification

    Kojima, T; Yamasaki, Y; Nishigake, D; Shirasaka, T; Kondo, M; Hioki, K; Kamitani, T; Kato, T; Ishigami, K

    BRITISH JOURNAL OF RADIOLOGY   98 ( 1168 )   600 - 606   2025.2   ISSN:0007-1285 eISSN:1748-880X

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    Objectives: To develop and validate the myocardial extracellular volume (ECV) obtained from non-electrocardiography (ECG)-gated delayed CT images acquired 4 min post-contrast infusion (4-min-non-ECG-ECV) compared with the ECV obtained from ECG-gated delayed CT images acquired 10 min post-contrast infusion (Conv-ECV). Methods: We retrospectively analysed 29 patients (males: 21) after a comprehensive CT protocol of both 4-min-non-ECG-ECV and Conv-ECV on a dual-layer CT scanner. The mean volume of contrast medium administered was 90 ± 11.8 mL, and the average heart rate during the CT examinations was 74.2 ± 18.2 bpm. Two independent observers calculated the respective 4-min-non-ECG-ECV and Conv-ECV. We determined the correlation between the ECV obtained by the 2 methods and conducted a Bland-Altman analysis to identify systematic errors and determine the limits of agreement (LOA) between the 4-min-non-ECG-ECV and Conv-ECV values. Results: The respective median ECV values for observer 1 were 27.3 for 4-min-non-ECG-ECV and 26.5 for Conv-ECV; for observer 2, they were 27.8 and 27.1. The correlation between the methods was 0.97 for both observers (P <. 01). The Bland-Altman plots for observers 1 and 2 demonstrated a minor bias (-0.2% and -0.5%, respectively), with the 95% LOA ranges at -4.4% to 4.0% and -5.0% to 4.0%, respectively. Conclusion: The 4-min-non-ECG-ECV provided ECV values comparable to those obtained by Conv-ECV. Advances in knowledge: Myocardial ECV quantification is feasible using a non-gated, 4-min delayed dual-energy CT scan with an already established CT acquisition method. This approach achieves ECV accuracy comparable to that of the conventional CT-ECV calculation method (gated 10-min delayed imaging) while enhancing clinical efficacy and diagnostic throughput.

    DOI: 10.1093/bjr/tqaf022

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  • Usefulness of Semiautomated 3D Volumetric Assessment of Liver Tumor Burden for Patients With Unresectable Pancreatic Neuroendocrine Tumor: A Pilot Study. International journal

    Nao Fujimori, Nobuhiro Fujita, Masatoshi Murakami, Akihisa Ohno, Kazuhide Matsumoto, Katsuhito Teramatsu, Keijiro Ueda, Noriaki Wada, Seiichiro Takao, Daisuke Okamoto, Kousei Ishigami, Tetsuhide Ito, Yoshihiro Ogawa

    Pancreas   54 ( 2 )   e122 - e129   2025.2   ISSN:0885-3177 eISSN:1536-4828

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    OBJECTIVES: In patients with metastatic pancreatic neuroendocrine tumors (PanNETs), the Ki-67 index is objectively assessed by pathologists; however, liver tumor burden (LTB) depends on the subjective judgment of physicians. This study aimed to elucidate the usefulness of the semi-automated 3D volumetric assessment of LTB in patients with PanNET. MATERIALS AND METHODS: We retrospectively reviewed 29 patients (40 computed tomographies [CTs]) with metastatic PanNETs. LTB was measured using a semiautomated 3D volumetric software program (volumetric assessment) or evaluated independently by 6 clinicians using CT imaging (visual assessment). The treatment map was classified into 3 groups based on LTB and Ki-67 index. RESULTS: Visual and volumetric assessments of the LTB were well correlated. The LTB was significantly higher on visual assessment than volumetric assessment (P < 0.01). Categorization on the map was consistent between the visual and volumetric evaluations in 23 patients (equal group). The remaining 6 patients were overestimated by visual assessment (overestimated group). Progression-free survival was significantly longer in patients in the 'equal group' than the 'overestimated group' (981 vs 366 days, P < 0.01). CONCLUSIONS: This pilot study revealed a good correlation between visual and volumetric assessments, and visual assessment overestimated LTB, compared to volumetric assessment.

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  • Clinical efficacy of pancreas-preserving distal pancreatectomy for the treatment of pancreatic ductal adenocarcinoma. International journal

    Naoki Ikenaga, Kohei Nakata, Toshiya Abe, Yusuke Watanabe, Noboru Ideno, Masatoshi Murakami, Keijiro Ueda, Nao Fujimori, Nobuhiro Fujita, Kousei Ishigami, Yoshihiro Ogawa, Masafumi Nakamura

    Surgery   178   108958 - 108958   2025.2   ISSN:0039-6060

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    BACKGROUND: The long-term survival rate of patients with pancreatic ductal adenocarcinoma has improved alongside the development of multidisciplinary treatment, and there is now demand for less invasive surgery that maintains postoperative pancreatic function. We evaluated the efficacy of pancreas-preserving distal pancreatectomy in terms of oncologic parameters and postoperative pancreatic function. METHODS: The data of 98 consecutive patients who underwent distal pancreatectomy for the treatment of pancreatic ductal adenocarcinoma between 2012 and 2022 in our institution were retrospectively analyzed. The surgical outcomes, overall survival, and postoperative pancreatic function were compared between pancreas-preserving distal pancreatectomy, in which the pancreatic stump was distal to the left margin of the portal vein on postoperative computed tomography, and conventional distal pancreatectomy. RESULTS: Sixteen patients (16%) underwent pancreas-preserving distal pancreatectomy. Fewer lymph nodes were dissected in the pancreas-preserving distal pancreatectomy group than the conventional distal pancreatectomy group (19 vs 31, respectively; P < .01); however, the R0 resection rate (94% vs 93%, respectively; P = 1.00), recurrence-free survival, and overall survival were similar. Similar results were obtained in an analysis limited to patients with pancreatic ductal adenocarcinoma in the pancreatic tail. Patients who underwent pancreas-preserving distal pancreatectomy were less likely to develop worsening of their diabetes than those who underwent conventional distal pancreatectomy (19% vs 39%, respectively; P = .16). Nonalcoholic fatty liver disease newly developed in 22% of the patients who underwent conventional distal pancreatectomy but in none of those who underwent pancreas-preserving distal pancreatectomy (P = .04). CONCLUSION: The pancreatic transection site should be distally located to preserve postoperative pancreatic function when R0 resection can be achieved.

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  • Artificial intelligence-assisted volume isotropic simultaneous interleaved bright- and black-blood examination for brain metastases (jan, 10.1007/s00234-024-03454-4, 2025)

    Kikuchi, K; Togao, O; Kikuchi, Y; Yamashita, K; Momosaka, D; Fukasawa, K; Nishimura, S; Toyoda, H; Obara, M; Hiwatashi, A; Ishigami, K

    NEURORADIOLOGY   67 ( 2 )   361   2025.1   ISSN:0028-3940 eISSN:1432-1920

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    Correction to: Neuroradiology. https://doi.org/10.1007/s00234-024-03454-4. The article “Artificial intelligence-assisted volume isotropic simultaneous interleaved bright- and black-blood examination for brain metastases”, written by Kazufumi Kikuchi, Osamu Togao, Yoshitomo Kikuchi, Koji Yamashita, Daichi Momosaka, Kazunori Fukasawa, Shunsuke Nishimura, Hiroyuki Toyoda, Makoto Obara, Akio Hiwatashi and Kousei Ishigami, was originally published electronically on the publisher’s internet portal on August 22, 2024 without open access. With the author(s)’ decision to opt for Open Choice, the copyright of the article changed on November 25, 2024 to © The Author(s) 2024 and the article is forthwith licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

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  • The cortical high-flow sign in oligodendroglioma, IDH-mutant and 1p/19q-codeleted is correlated with histological cortical vascular density. International journal

    Koji Yamashita, Ryo Murayama, Masahiro Itoyama, Kazufumi Kikuchi, Masaoki Kusunoki, Daisuke Kuga, Ryusuke Hatae, Yutaka Fujioka, Ryosuke Otsuji, Nobuhiro Fujita, Koji Yoshimoto, Kousei Ishigami, Osamu Togao

    Neuroradiology   67 ( 2 )   291 - 298   2025.1   ISSN:0028-3940 eISSN:1432-1920

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    BACKGROUND AND PURPOSE: The cortical high-flow sign has been more commonly reported in oligodendroglioma, IDH-mutant and 1p/19q-codeleted (ODG IDHm-codel) compared to diffuse glioma with IDH-wildtype or astrocytoma, IDH-mutant. Besides tumor types, higher grades of glioma might also contribute to the cortical high flow. Therefore, we investigated whether the histological cortical vascular density or CNS WHO grade was associated with the cortical high-flow sign in patients with ODG IDHm-codel. MATERIALS AND METHODS: This retrospective study consisted of pathologically confirmed 25 adult patients with ODG IDHm-codel. We implemented pseudo-continuous arterial spin labeling technique with background suppression. Subtraction images were generated from paired control and label images. Tumor-affecting cortices without intense contrast enhancement on conventional MR imaging were targeted for the determination of the cortical high-flow sign. Immunohistochemical staining of CD31 antibody was performed for the identification of vascular endothelial cells. A microscopic field of the most intense vascularization was captured in each specimen. The vessel number and the relative vascular density (%Vessel) were compared between the positive cortical high-flow sign (CHFS+) and the negative cortical high-flow sign (CHFS-) groups using the Mann-Whitney U test. Second, Fisher's exact test was used to compare the difference between the presence or absence of cortical high-flow sign and CNS WHO grades. Finally, the vessel number and %Vessel were compared between the CNS WHO grade 2 and grade 3 using the Mann-Whitney U test. RESULTS: The vessel number and %Vessel were higher in patients with the CHFS+ group than in patients with CHFS- group (p = 0.016 and p = 0.005, respectively). We observed no significant differences (p = 1.00) in the frequency of cortical high-flow sign between the CNS WHO grade 2 and grade 3. In addition, no significant differences are found in the vessel number and %Vessel between the CNS WHO grade 2 and grade 3 (p = 0.121 and p = 0.475, respectively). CONCLUSION: The cortical high-flow sign on ASL, which is more commonly found in ODG IDHm-codel than in diffuse glioma with IDH-wildtype or astrocytoma, is associated with the histological cortical vascular density in patients with ODG IDHm-codel.

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  • Sentinel Lymph Node Detection Using SPECT and Gamma Probe in Low-Risk Endometrial Cancer: Efficacy and Factors Associated With Detection Failure.

    Kazuo Asanoma, Hideaki Yahata, Keisuke Kodama, Kaoru Okugawa, Masafumi Yasunaga, Ichiro Onoyama, Hiroshi Yagi, Shoji Maenohara, Kazuhisa Hachisuga, Takuro Isoda, Mototsugu Shimokawa, Kousei Ishigami, Yoshinao Oda, Kiyoko Kato

    Asian journal of endoscopic surgery   18 ( 1 )   e70015   2025.1   ISSN:1758-5902 eISSN:1758-5910

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    INTRODUCTION: This study examined factors that affected sentinel lymph node (SLN) identification of patients with endometrial cancer having a preoperative estimation of low recurrent risk. METHODS: This study included 97 patients with endometrial cancer who attempted to identify SLN using a uterine cervical injection of technetium-99 m phytate under laparoscopic or robotic-assisted surgery at our institute. A preoperative single photon emission computed tomography (SPECT) and intraoperative gamma probe were used to detect hot nodes. Multiple clinical factors, including age, body mass index (BMI), and so on, were investigated for their association with SLN mapping failure. RESULTS: Among 97 cases, SPECT failed to detect SLN unilaterally in 38 cases (39%) and on both sides in 9 cases (9%). Meanwhile, the gamma probe failed to detect SLN unilaterally in 23 cases (24%) and on both sides in 3 cases (3%). While only age was significantly associated with SLN detection failure using the SPECT detection system, both age and BMI were significantly associated with SLN detection failure using the gamma probe detection system. When limiting to the preoperative SLN detection failure cohort of 47 cases, there was a strong association between intraoperative SLN detection failure and BMI, but not age. CONCLUSION: The SLN biopsy system was effectively applied to patients with endometrial cancer who underwent minimally invasive surgery (MIS). Attempts to improve SLN identification in older patients and those with obesity are warranted to obtain maximum benefits of MIS for low- or medium-risk cases.

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  • Noninvasive machine-learning models for the detection of lesion-specific ischemia in patients with stable angina with intermediate stenosis severity on coronary CT angiography

    Hamasaki, H; Arimura, H; Yamasaki, Y; Yamamoto, T; Fukata, M; Matoba, T; Kato, T; Ishigami, K

    PHYSICAL AND ENGINEERING SCIENCES IN MEDICINE   48 ( 1 )   167 - 180   2024.12   ISSN:2662-4729 eISSN:2662-4737

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    This study proposed noninvasive machine-learning models for the detection of lesion-specific ischemia (LSI) in patients with stable angina with intermediate stenosis severity based on coronary computed tomography (CT) angiography. This single-center retrospective study analyzed 76 patients (99 vessels) with stable angina who underwent coronary CT angiography (CCTA) and had intermediate stenosis severity (40-69%) on invasive coronary angiography. LSI, defined as a resting full-cycle ratio < 0.86 or fractional flow reserve ≤ 0.80, was determined in 40 patients (46 vessels) using a hybrid resting full-cycle ratio-fractional flow reserve strategy. The resting full-cycle ratio and/or fractional flow reserve were measured using invasive coronary angiography as references for functional severity indices of coronary stenosis in the machine-learning models. LSI detection models were constructed using noninvasive machine-learning models that predicted the resting full-cycle ratio and fractional flow reserve by feeding machine-learning models with image features extracted from CCTA. The diagnostic performance of the proposed LSI detection models was assessed using a nested 10-fold cross-validation test. The LSI detection models with the highest diagnostic performance achieved an accuracy of 0.88 (95% CI: 0.81, 0.94), sensitivity of 0.78 (95% CI: 0.70, 0.86) and specificity of 0.96 (95% CI: 0.92, 1.00) on a vessel basis and 0.88 (95% CI: 0.81, 0.95), 0.80 (95% CI: 0.70, 0.86) and 0.97 (95% CI: 0.92, 1.00), respectively, on a patient basis. These findings suggest that LSI detection models with features extracted from CCTA can noninvasively detect LSI in patients with stable angina with intermediate stenosis severity.

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  • Improvement of image quality of dentomaxillofacial region in ultra-high-resolution CT: a phantom study

    Sakai, Y; Okamura, K; Kitamoto, E; Shirasaka, T; Kato, T; Chikui, T; Ishigami, K

    DENTOMAXILLOFACIAL RADIOLOGY   54 ( 3 )   203 - 209   2024.12   ISSN:0250-832X eISSN:1476-542X

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    Objectives: The purpose of this study was to compare the image quality of ultra-high-resolution CT (U-HRCT) with that of conventional multidetector row CT (convCT) and demonstrate its usefulness in the dentomaxillofacial region. Methods: Phantoms were helically scanned with U-HRCT and convCT scanners using clinical protocols. In U-HRCT, phantoms were scanned in super-high-resolution (SHR) mode, and hybrid iterative reconstruction (HIR) and filtered-back projection (FBP) techniques were performed using a bone kernel (FC81). The FBP technique was performed using the same kernel as in convCT (reference). Two observers independently evaluated the 54 resulting images using a 5-point scale (5 = excellent diagnostic image quality; 4 = above average; 3 = average; 2 = subdiagnostic; and 1 = unacceptable). The system performance function (SPF) was calculated for a comprehensive evaluation of the image quality using the task transfer function and noise power spectrum. Statistical analysis using the Kruskal-Wallis test was performed to compare the image quality among the 3 protocols. Results: The observers assigned higher scores to images acquired with the SHRHIR and SHRFBP protocols than to those acquired with the reference (P < 0.0001 and P < 0.0001, respectively). The relative SPF value at 1.0 cycles/mm in SHRHIR and SHRFBP compared to the reference protocol were 151.5% and 45.6%, respectively. Conclusions: Through phantom experiments, this study demonstrated that U-HRCT can provide superior-quality images compared to conventional CT in the dentomaxillofacial region. The development of a better image reconstruction method is required to improve image quality and optimize the radiation dose.

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  • Evaluation of Renal Perfusion: A Comparative Study between Intravoxel Incoherent Motion (IVIM) Imaging and Arterial Spin Labeling (ASL) to Assess Renal Blood Flow in Rodents

    Ishimatsu, K; Kikuchi, K; Moe, OW; Oshio, K; Ishigami, K; Takahashi, M

    MAGNETIC RESONANCE IN MEDICAL SCIENCES   2024.12   ISSN:1347-3182 eISSN:1880-2206

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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. International journal

    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   ISSN:2352-0477 eISSN: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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  • Value of gadoxetic acid-enhanced MR imaging for preoperative prediction of future liver regeneration after hemihepatectomy.

    Nobuhiro Fujita, Yasuhiro Ushijima, Masahiro Itoyama, Daisuke Okamoto, Keisuke Ishimatsu, Kosuke Tabata, Shinji Itoh, Kousei Ishigami

    Japanese journal of radiology   42 ( 12 )   1439 - 1447   2024.12   ISSN:1867-1071 eISSN:1867-108X

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    PURPOSE: Liver resection is currently considered the most effective treatment for patients with liver cancer. To the best of our knowledge, no study has investigated the association between gadoxetic acid-enhanced magnetic resonance imaging (MRI) findings and liver regeneration in patients who underwent hemihepatectomy. We aimed to clarify the relationship between the signal intensity (SI) of the liver parenchyma on gadoxetic acid-enhanced MRI and the degree of liver regeneration in patients who underwent hemihepatectomy. MATERIALS AND METHODS: Forty-one patients who underwent gadoxetic acid-enhanced MRI before hemihepatectomy were enrolled. We calculated the liver-to-erector spinae muscle SI ratio (LMR) in the hepatobiliary phase and the precontrast images. ΔLMR was calculated using the following equation: ΔLMR = (LMR in the hepatobiliary phase-LMR in the precontrast image)/LMR in the precontrast image. The preoperative and postoperative remnant liver volumes (LVs) were calculated using CT volumetry. We calculated the resection rate (RR) and liver regeneration index (LRI) using the following formulas: RR = Resected LV/Total LV × 100 and LRI = (postoperative remnant LV-preoperative remnant LV)/preoperative remnant LV × 100. The relationships among LRI, imaging, and clinicopathological factors were analyzed. RESULTS: Univariate analysis showed RR and ΔLMR showed a positive correlation with LRI (ρ = 0.4133, p = 0.0072 and ρ = 0.7773, p < 0.001, respectively). Spleen volume showed a negative correlation with LRI (ρ = -0.3138, p = 0.0486). Stepwise multiple regression analysis showed ΔLMR and RR were independently correlated with LRI (β coefficient = 44.8771, p = 0.0198 and β coefficient = 1.9653, p < 0.001, respectively). CONCLUSION: ΔLMR may serve as a preoperative predictor of liver regeneration in patients undergoing hemihepatectomy.

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  • 特集1 絶対苦手分野にしない 消化管の画像診断 胃癌のCTどこまで読める?

    西牟田 雄祐, 鶴丸 大介, 石神 康生

    臨床画像   40 ( 11 )   1286 - 1293   2024.11   ISSN:09111069

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  • 特集1 絶対苦手分野にしない 消化管の画像診断 消化管間質腫瘍(GIST)のすべて

    鶴丸 大介, 井上 明星, 西牟田 雄祐, 南條 勝哉, 石神 康生

    臨床画像   40 ( 11 )   1302 - 1310   2024.11   ISSN:09111069

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  • Improving Vessel Visibility and Applying Artificial Intelligence to Autodetect Brain Metastasis for a 3D MR Imaging Sequence Capable of Simultaneous Images with and without Blood Vessel Suppression.

    Kazufumi Kikuchi, Makoto Obara, Yoshitomo Kikuchi, Koji Yamashita, Tatsuhiro Wada, Akio Hiwatashi, Kousei Ishigami, Osamu Togao

    Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine   2024.11   ISSN:1347-3182 eISSN:1880-2206

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    PURPOSE: The purposes of this study were 1) to improve vessel visibility of our MR sequence by modifying k-space filling and 2) to verify the usefulness of applying artificial intelligence (AI) for volume isotropic simultaneous interleaved bright- and black-blood examination (VISIBLE) with compressed sensitivity encoding (CS) in autodetecting brain metastases. METHODS: We modified 3 sequences of VISIBLE (Centric, Reversed Centric, and Startup Echo 30). The Centric sequence is a prototype. The Reversed Centric filled the k-space in a reversed centric manner to improve vessel visibility. The Startup Echo 30 implemented dummy echoes to further improve vessel visibility. Vessel visibility was evaluated in one slice at the level of the centrum semiovale. The sensitivity, specificity, the area under the curve (AUC), and false positives of detecting brain metastases using AI were evaluated among 3 sequences. Statistical comparisons were performed using a one-way analysis of variance, followed by Friedman and Dunn's multiple comparison tests. RESULTS: The number of visualized vessels was significantly lower in the Centric (39.3 ± 9.7, P < 0.05) and Reversed Centric (44.2 ± 9.8, P < 0.05) methods than in the magnetization-prepared rapid gradient echo (49.3 ± 9.1) but comparable in the Startup Echo 30 method (44.9 ± 8.8, P > 0.05). No significant differences existed in sensitivity, specificity, and AUC among the 3 methods. False positives achieved using the Reversed Centric method were significantly fewer (54 false positives) than those achieved using the Centric (85 false positives) and Startup Echo 30 (68 false positives) methods (P = 0.0092). CONCLUSION: Vessel visibility was improved by modifying the k-space filling, which may reduce false positives. The AI model for VISIBLE with CS achieved good performance in autodetection of brain metastases. The AI model for VISIBLE with CS can help radiologists diagnose brain metastases in clinical practice.

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  • Esophageal lymphangioma: Endoscopic ultrasound, computed tomography, and magnetic resonance imaging appearance. International journal

    Katsuya Nanjo, Daisuke Tsurumaru, Masakazu Hirakawa, Yusuke Nishimuta, Koshi Mimori, Kousei Ishigami

    Radiology case reports   19 ( 11 )   4841 - 4844   2024.11   ISSN:1930-0433

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    A case of esophageal lymphangioma in a 75-year-old man who complained of worsening dysphagia is presented. Endoscopic ultrasound showed an echogenic pattern of honeycomb or grid-like multiple microcysts within the submucosa. The sagittal image of computed tomography showed a thickened esophageal wall and fluid retention in the proximal esophageal lumen. Magnetic resonance imaging showed a high signal intensity mass with a septate-like internal structure on T2-weighted imaging and short tau inversion recovery. The tumor was completely resected by endoscopic submucosal dissection. Esophageal lymphangioma is a rare submucosal tumor that can be precisely diagnosed by CT and/or MRI.

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  • CT colonography has advantages over colonoscopy for size measurement of colorectal polyps.

    Daisuke Tsurumaru, Yusuke Nishimuta, Katsuya Nanjo, Satohiro Kai, Mitsutoshi Miyasaka, Toshio Muraki, Kousei Ishigami

    Japanese journal of radiology   42 ( 11 )   1255 - 1261   2024.11   ISSN:1867-1071 eISSN:1867-108X

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    PURPOSE: The aim of this study was to compare the accuracy of colonoscopy (CS) and CT colonography (CTC) in the measurement of colorectal polyps using pathological size as a reference. MATERIALS AND METHODS: The analysis included 61 colorectal polyps in 28 patients who underwent preoperative CTC at our institution. All polyps were endoscopically resected. Polyp sizes were measured by CS and CTC. Endoscopic polyp size was extracted from endoscopy records written by one of two endoscopists (A with 11 and B with 6 years of endoscopic experience, respectively), who estimated the size visually/categorically without any measuring devices. After matching the location, the polyp size was measured on CTC using manual three-dimensional (3D) measurement on a workstation. The sizes of resected polyps were also measured after pathological inspection. Differences of the polyp size between CTC and histology, and between CS and histology were compared using paired t tests. Differences in measurement between the two endoscopists were also analyzed. RESULTS: The mean diameters of polyps measured using CS, CTC, and pathology were 10.5 mm, 9.2 mm, and 8.4 mm, respectively. There was a significant correlation between CS and pathology, as well as between CTC and pathology (both P < 0.0001). The correlation coefficient for CS (r = 0.86) was lower than that for CTC (r = 0.96). The correlations between CS and pathology for endoscopists A and B were 0.90 and 0.89, respectively. CONCLUSION: Measurements of polyp size using CTC were closer to the pathological measurements compared to those by CS, which exhibited greater variability. This suggests that CTC may be more suitable for polyp size measurements in the clinical setting if patients undergo CTC concurrently with colonoscopy.

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  • 特集 必見! 画像診断医のための各種ガイドラインの読み解き方 消化管領域−消化管癌のアップデートおよび日常臨床で注意すべき消化管疾患−

    下村 悠太朗, 鶴丸 大介, 篠﨑 賢治, 宮坂 光俊, 村木 俊夫, 石神 康生

    臨床画像   40 ( 14 )   88 - 98   2024.10   ISSN:09111069

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  • Improvement of image quality for bright-blood image in VISIBLE (volume isotropic simultaneous interleaved bright- and black-blood examination) by using k-space reordering and startup echoes. International journal

    Tatsuhiro Wada, Kazufumi Kikuchi, Makoto Obara, Chiaki Tokunaga, Koji Yamashita, Koji Kobayashi, Toyoyuki Kato, Kousei Ishigami, Osamu Togao

    Magnetic resonance imaging   112   144 - 150   2024.10   ISSN:0730-725X eISSN:1873-5894

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    PURPOSE: A volume isotropic simultaneous interleaved bright- and black-blood examination (VISIBLE) can simultaneously acquire images with suppressed vascular signals (black-blood images) and images without suppression (bright-blood images). We aimed to improve of the bright-blood images by adjusting the k-space filling and using startup echo. METHODS: The k-space arrangement of bright-blood images in the conventional VISIBLE followed a low-to-high frequency order, whereas that in the proposed VISIBLE sequence was in the reversed order, and a startup echo was added. The effects of startup echo on the signal-to-noise ratio (SNR) were evaluated using phantoms, considering both white matter (WM) and post-contrast blood. Data from copper sulfate phantoms were acquired in 1D Fourier transform mode using both the conventional and proposed methods of the two VISIBLE sequences. The signal behavior with each sequence was evaluated. Fourteen patients with a total of 21 metastases were included in the study. For each patient, VISIBLE images of both conventional and proposed methods were obtained consecutively after the contrast agent administration. Using clinical images, we conducted a comparison of the SNR and contrast-to-noise ratio (CNR) for tumors, normal WM, and blood vessels between the conventional and proposed VISIBLE sequences. RESULTS: There was no significant difference in SNRs for both black- and bright-blood images between the conventional sequence and the proposed sequence with different number of startup echoes, however, the SNR of the proposed sequence decreased with increasing number of startup echoes in both black- and bright-images. The signal behavior of the bright-blood image reached a "steady state" when the startup echo exceeded 20. The SNRs of blood vessels in the bright-blood images did not differ significantly between conventional and proposed VISIBLE sequences. The SNRs of WM in the bright-blood images was significantly larger in the conventional sequence than in the proposed sequence. The SNRs of tumors in bright blood images was significantly larger in the proposed sequence than in the conventional sequence. The CNRs between tumors and WM, vessels and WM in the bright-blood images were significantly higher in the proposed sequence than in the conventional sequence. CONCLUSION: The use of the startup echo in combination with the high-to-low frequency k-space ordering method resulted in improved CNR of the bright-blood images in the VISIBLE sequence.

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  • 連載 何としても読んでもらいたい あの論文,この論文 第26回 日常診療での気付きや疑問を積極的に検証する醍醐味

    石神 康生

    臨床画像   40 ( 9 )   1158 - 1159   2024.9   ISSN:09111069

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  • 特集 肝胆膵のcommon diseaseにみる非典型的画像所見 膵漿液性嚢胞腫瘍(SCN)

    牧瀬 智, 藤田 展宏, 中山 智博, 牛島 泰宏, 岡本 大佑, 石松 慶祐, 田畑 公佑, 石神 康生

    画像診断   44 ( 12 )   1202 - 1208   2024.9   ISSN:02850524 eISSN:24321281

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  • A case of preoperative embolization for a giant hypervascular pancreatic serous cystic neoplasm in pancreaticoduodenectomy. International journal

    Takahito Matsuyoshi, Naoki Ikenaga, Kohei Nakata, Daisuke Okamoto, Takashi Matsumoto, Toshiya Abe, Yusuke Watanabe, Noboru Ideno, Keizo Kaku, Nao Fujimori, Kenoki Ohuchida, Yasuhiro Okabe, Yoshinao Oda, Kousei Ishigami, Masafumi Nakamura

    Surgical case reports   10 ( 1 )   208 - 208   2024.9   ISSN:2198-7793

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    BACKGROUND: Preoperative vascular embolization is an effective strategy for managing meningiomas, neck paragangliomas, renal cell carcinomas, and bone metastasis by reducing the intraoperative bleeding volume and operation time. Although hypervascular tumors also occur in the pancreas, preoperative embolization for these tumors is not commonly practiced. We herein present a case of a giant serous cystic neoplasm (SCN) of the pancreas with significant arterial vascularity that was managed with preoperative interventional radiology and subsequently resected via pancreaticoduodenectomy. CASE PRESENTATION: A 60-year-old man presented with an 8-cm hypervascular tumor located at the head of the pancreas, identified as an SCN on pathologic examination. The tumor had increased by 13 mm over 5 years, necessitating surgical intervention. Computed tomography revealed a substantial blood supply to the tumor from the dorsal pancreatic artery and gastroduodenal artery, both branches of the superior mesenteric artery. To mitigate the risk of severe intraoperative bleeding from this giant hypervascular tumor, branches of the dorsal pancreatic artery and gastroduodenal artery were embolized using metallic coils and further secured using a gelatin sponge 1 day prior to pancreatectomy. During the laparotomy, the tumor appeared to have decreased in size, likely because of reduced distension and congestion. Despite significant adhesions to surrounding tissues secondary to prolonged compression and inflammation, the pancreaticoduodenectomy was completed successfully in 5 h and 15 min with blood loss of 763 mL. The patient was discharged on postoperative day 15 without complications. CONCLUSIONS: Preoperative arterial embolization for hypervascular pancreatic tumors might control the risk of massive intraoperative bleeding, contributing to a favorable postoperative outcome. Utilizing interventional radiology for preoperative inflow control is one of the beneficial strategies for pancreatectomy in patients with a giant SCN.

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  • Different Impact of Immunosuppressive Therapy on Cardiac Outcomes in Systemic Versus Isolated Cardiac Sarcoidosis.

    Tomoka Masunaga, Toru Hashimoto, Takeo Fujino, Kisho Ohtani, Yusuke Ishikawa, Tomoaki Yoshitake, Keisuke Shinohara, Shouji Matsushima, Tomomi Ide, Yuzo Yamasaki, Takuro Isoda, Shingo Baba, Kousei Ishigami, Hiroyuki Tsutsui, Shintaro Kinugawa

    International heart journal   65 ( 5 )   856 - 865   2024.9   ISSN:1349-2365 eISSN:1349-3299

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    Isolated cardiac sarcoidosis (iCS) is increasingly recognized; however, its prognosis and the efficacy of immunosuppressive therapy remain undetermined. We aimed to compare the prognosis of iCS and systemic sarcoidosis including cardiac involvement (sCS) under immunosuppressive therapy.We retrospectively reviewed the clinical data of 42 patients with sCS and 30 patients with iCS diagnosed at Kyushu University Hospital from 2004 through 2022. We compared the characteristics and the rate of adverse cardiac events including cardiac death, fatal ventricular tachyarrhythmia, and heart failure hospitalization between the 2 groups. The median follow-up time was 1535 [interquartile range, 630-2555] days, without a significant difference between the groups. There were no significant differences in gender, NYHA class, or left ventricular ejection fraction. Immunosuppressive agents were administered in 86% of sCS and in 73% of iCS patients (P = 0.191). When analyzed only with patients receiving immunosuppressive therapy (sCS, n = 36; iCS, n = 21), the cardiac event-free survival was significantly lower in iCS than sCS (37% versus 79%, P = 0.002). Myocardial LGE content at the initial diagnosis was comparable in both groups. The disease activity was serially evaluated in 26 sCS and 16 iCS patients by quantitative measures of FDG-PET including cardiac metabolic volume and total lesion glycolysis, representing 3-dimensional distribution and intensity of inflammation in the entire heart. Although iCS patients had lower baseline disease activity than sCS patients, immunosuppressive therapy did not attenuate disease activity in iCS in contrast to sCS.iCS showed a poorer response to immunosuppressive therapy and a worse cardiac prognosis compared to sCS despite lower baseline disease activity.

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  • Artificial intelligence-assisted volume isotropic simultaneous interleaved bright- and black-blood examination for brain metastases. International journal

    Kazufumi Kikuchi, Osamu Togao, Yoshitomo Kikuchi, Koji Yamashita, Daichi Momosaka, Kazunori Fukasawa, Shunsuke Nishimura, Hiroyuki Toyoda, Makoto Obara, Akio Hiwatashi, Kousei Ishigami

    Neuroradiology   67 ( 2 )   351 - 359   2024.8   ISSN:0028-3940 eISSN:1432-1920

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    PURPOSE: To verify the effectiveness of artificial intelligence-assisted volume isotropic simultaneous interleaved bright-/black-blood examination (AI-VISIBLE) for detecting brain metastases. METHODS: This retrospective study was approved by our institutional review board and the requirement for written informed consent was waived. Forty patients were included: 20 patients with and without brain metastases each. Seven independent observers (three radiology residents and four neuroradiologists) participated in two reading sessions: in the first, brain metastases were detected using VISIBLE only; in the second, the results of the first session were comprehensively evaluated by adding AI-VISIBLE information. Sensitivity, diagnostic performance, and false positives/case were evaluated. Diagnostic performance was assessed using a figure-of-merit (FOM). Sensitivity and false positives/case were evaluated using McNemar and paired t-tests, respectively. RESULTS: The McNemar test revealed a significant difference between VISIBLE with/without AI information (P < 0.0001). Significantly higher sensitivity (94.9 ± 1.7% vs. 88.3 ± 5.1%, P = 0.0028) and FOM (0.983 ± 0.009 vs. 0.972 ± 0.013, P = 0.0063) were achieved using VISIBLE with AI information vs. without. No significant difference was observed in false positives/case with and without AI information (0.23 ± 0.19 vs. 0.18 ± 0.15, P = 0.250). AI-assisted results of radiology residents became comparable to results of neuroradiologists (sensitivity, FOM: 85.9 ± 3.4% vs. 90.0 ± 5.9%, 0.969 ± 0.016 vs. 0.974 ± 0.012 without AI information; 94.8 ± 1.3% vs. 95.0 ± 2.1%, 0.977 ± 0.010 vs. 0.988 ± 0.005 with AI information, respectively). CONCLUSION: AI-VISIBLE improved the sensitivity and performance for diagnosing brain metastases.

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  • 特集 これからの胃癌診療 4.胃癌の放射線診断

    西牟田 雄祐, 鶴丸 大介, 甲斐 聖広, 南條 勝哉, 石神 康生

    臨床消化器内科   39 ( 8 )   872 - 881   2024.7   ISSN:0911601X eISSN:24332488

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    DOI: 10.19020/cg.0000003106

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  • 特集 悪性リンパ腫の画像診断:間違えやすい疾患との鑑別のポイント 消化管

    南條 勝哉, 西牟田 雄祐, 鶴丸 大介, 鳥巣 剛弘, 石神 康生

    臨床放射線   69 ( 4 )   473 - 482   2024.7   ISSN:00099252

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    DOI: 10.18888/rp.0000002708

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  • Prognostic significance of preoperative creatine kinase in resected thymic epithelial tumors. International journal

    Asato Hashinokuchi, Shinkichi Takamori, Masafumi Yamaguchi, Saito Shunichi, Kyoto Matsudo, Taichi Nagano, Fumihiko Kinoshita, Takaki Akamine, Mikihiro Kohno, Mototsugu Shimokawa, Kousei Ishigami, Tomoyoshi Takenaka, Tomoharu Yoshizumi

    Journal of thoracic disease   16 ( 7 )   4186 - 4194   2024.7   ISSN:2072-1439 eISSN:2077-6624

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    BACKGROUND: The preoperative serum creatine kinase (CK) concentration is a prognostic factor for malignant diseases. We investigated the significance of CK in surgically resected thymic epithelial tumors and the relationship between CK and clinicopathological factors. METHODS: We retrospectively evaluated the relationship between preoperative CK levels and prognosis in 120 patients with thymic epithelial tumors who underwent surgical resection at two centers. The cutoff for CK was determined by the standard value in our institution (<62 IU/L for men and <45 IU/L for women). The paravertebral muscle at the Th12 level was used to assess skeletal muscle area to investigate sarcopenia. RESULTS: Eighteen patients (15.0%) were categorized into the low CK group. The CK level was not associated with age, sex, performance status, myasthenia gravis, and pathological findings. Preoperative serum albumin and total cholesterol concentrations were significantly lower in the low CK group than in the normal CK group (both P<0.001). Moreover, the Th12 muscle index was lower in the low CK group (P=0.03), indicating that low CK was related to sarcopenia. Kaplan-Meier curve analysis illustrated that patients in the low CK group had significantly shorter disease-free survival (DFS) and overall survival (OS) than those in the normal CK group (P=0.03 and P=0.002, respectively). Multivariate analysis identified low CK as an independent prognostic factor for DFS (P=0.03) and OS (P=0.005). CONCLUSIONS: Preoperative serum CK might reflect the host nutritional status in patients with resected thymic epithelial tumors; therefore, CK could be a biomarker of postoperative prognosis.

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  • Correction to: Multiparametric assessment of microvascular invasion in hepatocellular carcinoma using gadoxetic acid-enhanced MRI. International journal

    Nobuhiro Fujita, Yasuhiro Ushijima, Keisuke Ishimatsu, Daisuke Okamoto, Noriaki Wada, Seiichiro Takao, Ryo Murayama, Masahiro Itoyama, Noboru Harada, Junki Maehara, Yoshinao Oda, Kousei Ishigami, Akihiro Nishie

    Abdominal radiology (New York)   49 ( 7 )   2559 - 2560   2024.7   ISSN:2366-004X eISSN:2366-0058

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    In this paper, references from 25 to 40 are incorrect in the original publication. The correct references are given below: Bastati N, Wibmer A, Tamandl D, et al. (2016) Assessment of Orthotopic Liver Transplant Graft Survival on Gadoxetic Acid-Enhanced Magnetic Resonance Imaging Using Qualitative and Quantitative Parameters. Invest Radiol 51:728–734. Bastati N, Beer L, Mandorfer M, et al. (2020) Does the Functional Liver Imaging Score Derived from Gadoxetic Acid-enhanced MRI Predict Outcomes in Chronic Liver Disease Radiology 294:98–107. Torbenson MS, Ng IOL, Park YN, Roncalli M, Sakamoto M (2019). Hepatocellular carcinoma. In: WHO classification of Tumors Editorial Board. Digestive system tumours. Lyon (France): Internal Agency for Research on Cancer: pp229-239. Roayaie S, Blume IN, Thung SN et al. (2009) A system of classifying microvascular invasion to predict outcome after resection in patients with hepatocellular carcinoma. Gastroenterology 137:850–855. Tomimaru Y, Sasaki Y, Yamada T et al. (2006) Fibrosis in non-cancerous tissue is the unique prognostic factor for primary hepatocellular carcinoma without hepatitis B or C viral infection. World J Surg 30:1729–1735. Esnaola NF, Lauwers GY, Mirza NQ et al. (2002) Predictors of microvascular invasion in patients with hepatocellular carcinoma who are candidates for orthotopic liver transplantation. J Gastrointest Surg 6:224–232; discussion 232. Ng IO, Lai EC, Ng MM, Fan ST (1992) Tumor encapsulation in hepatocellular carcinoma. A pathologic study of 189 cases. Cancer 70:45–49. Fujita N, Nishie A, Asayama Y et al. (2020) Quantitative evaluation of liver function and pathology with hepatocyte fraction on Gadoxetic acid-enhanced MR imaging Magn Reson Imaging 72:125–129. Rosenkrantz AB, Oei M, Babb JS, Niver BE, Taouli B (2011) Diffusion-weighted imaging of the abdomen at 3.0 tesla: image quality and apparent diffusion coefficient reproducibility compared with 1.5 tesla. J Magn Reson Imaging 33:128–135. Tang Y, Wang H, Wang Y, et al. (2016) Quantitative comparison of MR diffusion-weighted imaging for liver focal lesions between 3.0T and 1.5T: Regions of interest of the minimum-spot ADC, the largest possible solid part, and the maximum diameter in lesions J Magn Reson Imaging 44:1320–1329. Nishie A, Tajima T, Asayama Y et al. (2011) Diagnostic performance of apparent diffusion coefficient for predicting histological grade of hepatocellular carcinoma. Eur J Radiol. 80:e29-33. Yokoo T, Masaki N, Parikh ND, Lane BF et al. (2023) Multicenter validation of abbreviated MRI for detecting early-stage hepatocellular carcinoma. Radiology. 307:e220917. Ehman EC, Behr SC, Umetsu SE et al. (2016) Rate of observation and inter-observer agreement for LI-RADS major features at CT and MRI in 184 pathology proven hepatocellular carcinomas. Abdom Radiol (NY) 41:963–969. Matsui O, Kobayashi S, Sanada J et al. (2011) Hepatocelluar nodules in liver cirrhosis: hemodynamic evaluation (angiography-assisted CT) with special reference to multistep hepatocarcinogenesis. Abdom Imaging 36:264–272. Min JH, Lee MW, Park HS et al. (2020) Interobserver Variability and Diagnostic Performance of Gadoxetic Acid-enhanced MRI for Predicting Microvascular Invasion in Hepatocellular Carcinoma. Radiology 297: 573–581. Fan L, Mac MT, Frishberg DP et al. (2010) Interobserver and intraobserver variability in evaluating vascular invasion in hepatocellular carcinoma. J Gastroenterol Hepatol 25: 1556–1561. The original article has been updated.

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  • Influence of cardiac cycle on myocardial extracellular volume fraction measurements with dual-layer computed tomography. International journal

    Daisuke Nishigake, Yuzo Yamasaki, Tomoyuki Hida, Takashi Shirasaka, Ryohei Funatsu, Toyoyuki Kato, Kousei Ishigami

    Quantitative imaging in medicine and surgery   14 ( 7 )   4714 - 4722   2024.7   ISSN:2223-4292 eISSN:2223-4306

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    BACKGROUND: In cardiac computed tomography (CT), the best image quality is obtained at mid-diastole at low heart rates (HRs) and at end-systole at high HRs. On the other hand, extracellular volume (ECV) measurements may be influenced by the cardiac phase. Therefore, we aimed to clarify the influence of the cardiac phase on the image quality and ECV values obtained using dual-layer spectral computed tomography (DLCT). METHODS: Fifty-five patients (68.0±14.5 years; 26 men) with cardiac diseases who underwent retrospective electrocardiogram-gated myocardial CT delayed enhancement (CTDE) between February 2019 to April 2022 were enrolled. The ECVs at the right ventricle (RV) and left ventricle (LV) walls in the end-systolic and mid-diastolic phases were calculated using iodine-density measurements from CTDE spectral data. Iodine-density image quality was classified on a 4-point scale. ECV and image quality across cardiac phases were compared using the t-test and Wilcoxon signed-rank test, respectively. Inter- and intraobserver variability were evaluated using intraclass correlation coefficient (ICC) values. RESULTS: The ECV of the septal regions during mid-diastole was significantly higher than that during end-systole. Other regions showed similar ECV measurements in both groups (P=0.13-0.97), except for the LV anterior wall and LV posterior wall at the base-ventricular level. The image-quality score in end-systole was significantly higher than that in mid-diastole (systole vs. diastole: 3.6±0.5 vs. 3.2±0.7; P=0.0195). Intra- and interobserver variabilities for RV ECV measurements at the end-systolic phase were superior to those at the mid-diastolic phase, whereas the corresponding values for LV ECV measurements were similar. CONCLUSIONS: Septal ECV showed small but significant differences while other region ECV showed no difference during the cardiac cycle. RV ECV measurements in the end-systolic phase were more reproducible than those in the mid-diastolic phase.

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  • Evaluation of PTV margin in CBCT-based online adaptive radiation therapy for gastric mucosa-associated lymphoid tissue lymphoma. International journal

    Taka-Aki Hirose, Masanori Takaki, Yusuke Shibayama, Jun-Ichi Fukunaga, Toyoyuki Kato, Tadamasa Yoshitake, Kousei Ishigami

    Journal of radiation research   65 ( 4 )   507 - 511   2024.6   ISSN:0449-3060 eISSN:1349-9157

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    The aim of this study was to investigate planning target volume (PTV) margin in online adaptive radiation therapy (oART) for gastric mucosa-associated lymphoid tissue (MALT) lymphomas. Four consecutive patients with gastric MALT lymphoma who received oART (30 Gy in 15 fractions) on the oART system were included in this study. One hundred and twenty cone-beam computed tomography (CBCT) scans acquired pre- and post-treatment of 60 fractions for all patients were used to evaluate intra- and interfractional motions. Patients were instructed on breath-holding at exhalation during image acquisition. To assess the intrafraction gastric motion, different PTVs were created by isotropically extending the CTV contoured on a pre-CBCT image (CTVpre) at1 mm intervals. Intrafraction motion was defined as the amount of expansion covering the contoured CTV on post-CBCT images (CTVpost). Interfractional motion was defined as the amount of reference CTV expansion that could cover each CTVpre, as well as the evaluation of the intrafractional motion. PTV margins were estimated from the cumulative proportion of fraction covering the intra- and interfractional motions. The extent of expansion covering the CTVs in 90% of fractions was adopted as the PTV margin. The PTV margin for intrafractional gastric motion using the oART system with breath-holding was 14 mm. In contrast, the PTV margin for interfractional gastric organ motion without the oART system was 25 mm. These results indicated that the oART system can reduce the PTV margin by >10 mm. Our results could be valuable data for oART cases.

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  • Safety and clinical contribution of computed tomography-guided biopsy for cervical spine lesion

    Okamoto, D; Ushijima, Y; Fujita, N; Ishimatsu, K; Murayama, R; Itoyama, M; Ishigami, K

    MINIMALLY INVASIVE THERAPY & ALLIED TECHNOLOGIES   33 ( 3 )   171 - 175   2024.6   ISSN:1364-5706 eISSN:1365-2931

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    Introduction: The purpose is to clarify the safety and clinical contribution of computed tomography (CT)-guided percutaneous needle-biopsy for patients with cervical spine lesion. Material and methods: Between June 2015 and August 2022, CT-guided percutaneous needle biopsies were performed for 15 cervical spine lesions of 15 patients (8 male, 7 female; 2–81 years old). The technical success, clinical contribution, and safety were evaluated. Technical success was defined as the completion of the biopsy procedure. Clinical contribution was defined as any contribution to the therapeutic strategy. Safety was assessed by the Common Terminology Criteria for Adverse Events, version 5.0. Results: The technical success rate was 100%. In all 15 patients, nontarget organs (e.g., major vessels, spinal cord) could be avoided. The post-biopsy histological diagnoses were myeloma (n = 2), metastatic adenocarcinoma (n = 2), chordoma (n = 2), Langerhans cell histiocytosis (n = 3), and one case each of malignant lymphoma, schwannoma, pyogenic spondylitis, non-pyogenic spondylitis, degenerative change, and non-pathological fracture. All of these diagnoses contributed to the therapeutic strategy decisions. One case of grade 2 pain was observed, but no complications with grade 3 or more were observed during or after the biopsies. Conclusion: CT-guided percutaneous needle biopsies for cervical spine lesions were safe and clinically beneficial.

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  • CT colonographyを用いた早期大腸癌の深達度診断に関する検討

    鶴丸 大介, 西牟田 雄祐, 南條 勝哉, 甲斐 聖広, 沖 英次, 石神 康生

    日本大腸検査学会雑誌   40 ( 2 )   61 - 67   2024.6   ISSN:1344-1639

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    隆起型早期大腸癌は内視鏡での深達度診断が難しい場合がある。本研究ではCT colonography(CTC)の側面像に着目し、粘膜内癌(M癌)と粘膜下層癌(SM癌)の鑑別が可能かを検証した。2名の放射線科医による読影で、SM癌の診断の感度は63.6%、100.0%、特異度は77.8%、66.7%であった。本法は、早期大腸癌の深達度診断における補助的な診断法として有用であると考えられる。(著者抄録)

  • 特集1 まれに出会うと悩ましい 肝病変の画像診断 肝腫瘍治療後にまれにみられる肝病変や肝実質の変化

    友利 由佳理, 西江 昭弘, 石神 康生

    臨床画像   40 ( 5 )   600 - 611   2024.5   ISSN:09111069

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  • Multiparametric assessment of microvascular invasion in hepatocellular carcinoma using gadoxetic acid-enhanced MRI. International journal

    Nobuhiro Fujita, Yasuhiro Ushijima, Keisuke Ishimatsu, Daisuke Okamoto, Noriaki Wada, Seiichiro Takao, Ryo Murayama, Masahiro Itoyama, Noboru Harada, Junki Maehara, Yoshinao Oda, Kousei Ishigami, Akihiro Nishie

    Abdominal radiology (New York)   49 ( 5 )   1467 - 1478   2024.5   ISSN:2366-004X eISSN:2366-0058

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    PURPOSE: To elucidate how precisely microvascular invasion (MVI) in hepatocellular carcinoma (HCC) can be predicted using multiparametric assessment of gadoxetic acid-enhanced MRI. METHODS: In this retrospective single-center study, patients who underwent liver resection or transplantation of HCC were evaluated. Data obtained in patients who underwent liver resection were used as the training set. Nine kinds of MR findings for predicting MVI were compared between HCCs with and without MVI by univariate analysis, followed by multiple logistic regression analysis. Using significant findings, a predictive formula for diagnosing MVI was obtained. The diagnostic performance of the formula was investigated in patients who underwent liver resection (validation set 1) and in patients who underwent liver transplantation (validation set 2) using a receiver operating characteristic curve analysis. The area under the curves (AUCs) of these three groups were compared. RESULTS: A total of 345 patients with 356 HCCs were selected for analysis. Tumor diameter (D) (P = 0.021), tumor washout (TW) (P < 0.01), and peritumoral hypointensity in the hepatobiliary phase (PHH) (P < 0.01) were significantly associated with MVI after multivariate analysis. The AUCs for predicting MVI of the predictive formula were as follows: training set, 0.88 (95% confidence interval (CI) 0.82,0.93); validation set 1, 0.81 (95% CI 0.73,0.87); validation set 2, 0.67 (95% CI 0.51,0.80). The AUCs were not significantly different among three groups (training set vs validation set 1; P = 0.15, training set vs validation set 2; P = 0.09, validation set 1 vs validation set 2; P = 0.29, respectively). CONCLUSION: Our multiparametric assessment of gadoxetic acid-enhanced MRI performed quite precisely and with good reproducibility for predicting MVI.

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  • Advantages of 3D High-Resolution Vessel Wall Imaging in a Patient With Blood Blister-Like Aneurysm: A Case Report and Literature Review. International journal

    Toru Otsuka, Kazufumi Kikuchi, Osamu Togao, Koji Yamashita, Soh Takagishi, Koichi Arimura, Akira Nakamizo, Kousei Ishigami

    Cureus   16 ( 4 )   e58376   2024.4   ISSN:2168-8184 eISSN:2168-8184

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    Blood blister-like aneurysms (BBAs) are rare and challenging intracranial aneurysms. They pose significant diagnostic and surgical risks due to their delicate walls. Accounting for a small percentage of intracranial aneurysms, BBAs are pathologically pseudoaneurysms, often resulting from arterial dissection, with a high tendency to rupture. This report underscores the critical nature of BBAs by reviewing a case in which subarachnoid hemorrhage caused by a BBA rupture was difficult to diagnose with conventional imaging. We highlight the efficacy of three-dimensional (3D) high-resolution vessel wall imaging (VWI) in discerning the subtle vascular abnormality of BBAs. The integration of the black-blood imaging technique within VWI provides superior contrast between the aneurysm and surrounding tissues, facilitating clearer visualization of the aneurysmal wall. The use of 3D T1-weighted imaging provides intricate details of the vessel wall including its contrast enhancement, which is crucial for a comprehensive assessment of a ruptured aneurysm. This case is consistent with the existing literature, supporting the role of VWI in the identification of ruptured BBAs, an area with limited but growing information on its diagnostic value. VWI is precise and accurate in the preoperative diagnosis of BBAs, emphasizing its potential to improve patient management and outcomes, especially in conditions with high risks of morbidity and mortality.

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  • Brain volume measured by synthetic magnetic resonance imaging in adult moyamoya disease correlates with cerebral blood flow and brain function. International journal

    Kazufumi Kikuchi, Osamu Togao, Koji Yamashita, Takuro Isoda, Ataru Nishimura, Koichi Arimura, Akira Nakamizo, Koji Yoshimoto, Kousei Ishigami

    Scientific reports   14 ( 1 )   5468 - 5468   2024.3   ISSN:2045-2322

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    Moyamoya disease (MMD) is characterized by progressive arterial occlusion, causing chronic hemodynamic impairment, which can reduce brain volume. A novel quantitative technique, synthetic magnetic resonance imaging (SyMRI), can evaluate brain volume. This study aimed to investigate whether brain volume measured with SyMRI correlated with cerebral blood flow (CBF) and brain function in adult MMD. In this retrospective study, 18 adult patients with MMD were included. CBF was measured using iodine-123-N-isopropyl-p-iodoamphetamine single photon emission computed tomography. Cerebrovascular reactivity (CVR) to acetazolamide challenge was also evaluated. Brain function was measured using the Wechsler Adult Intelligence Scales (WAIS)-III/IV and the WAIS-R tests. Gray matter (GM), white matter, and myelin-correlated volumes were evaluated in six areas. Resting CBF was positively correlated with GM fractions in the right anterior cerebral arterial and right middle cerebral arterial (MCA) territories. CVR was positively correlated with GM fraction in the right posterior cerebral arterial (PCA) territory. Full-Scale Intelligence Quotient and Verbal Comprehension Index scores were marginally positively correlated with GM fractions in the left PCA territory. Processing Speed Index score was marginally positively correlated with GM fraction in the right MCA territory. The SyMRI-measured territorial GM fraction correlated with CBF and brain function in patients with MMD.

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  • Comparison of diagnostic performance of radiologist- and AI-based assessments of T2-FLAIR mismatch sign and quantitative assessment using synthetic MRI in the differential diagnosis between astrocytoma, IDH-mutant and oligodendroglioma, IDH-mutant and 1p/19q-codeleted. International journal

    Kazufumi Kikuchi, Osamu Togao, Koji Yamashita, Daichi Momosaka, Yoshitomo Kikuchi, Daisuke Kuga, Sangatsuda Yuhei, Yutaka Fujioka, Fumiya Narutomi, Makoto Obara, Koji Yoshimoto, Kousei Ishigami

    Neuroradiology   66 ( 3 )   333 - 341   2024.3   ISSN:0028-3940 eISSN:1432-1920

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    PURPOSE: This study aimed to compare assessments by radiologists, artificial intelligence (AI), and quantitative measurement using synthetic MRI (SyMRI) for differential diagnosis between astrocytoma, IDH-mutant and oligodendroglioma, and IDH-mutant and 1p/19q-codeleted and to identify the superior method. METHODS: Thirty-three cases (men, 14; women, 19) comprising 19 astrocytomas and 14 oligodendrogliomas were evaluated. Four radiologists independently evaluated the presence of the T2-FLAIR mismatch sign. A 3D convolutional neural network (CNN) model was trained using 50 patients outside the test group (28 astrocytomas and 22 oligodendrogliomas) and transferred to evaluate the T2-FLAIR mismatch lesions in the test group. If the CNN labeled more than 50% of the T2-prolonged lesion area, the result was considered positive. The T1/T2-relaxation times and proton density (PD) derived from SyMRI were measured in both gliomas. Each quantitative parameter (T1, T2, and PD) was compared between gliomas using the Mann-Whitney U-test. Receiver-operating characteristic analysis was used to evaluate the diagnostic performance. RESULTS: The mean sensitivity, specificity, and area under the curve (AUC) of radiologists vs. AI were 76.3% vs. 94.7%; 100% vs. 92.9%; and 0.880 vs. 0.938, respectively. The two types of diffuse gliomas could be differentiated using a cutoff value of 2290/128 ms for a combined 90th percentile of T1 and 10th percentile of T2 relaxation times with 94.4/100% sensitivity/specificity with an AUC of 0.981. CONCLUSION: Compared to the radiologists' assessment using the T2-FLAIR mismatch sign, the AI and the SyMRI assessments increased both sensitivity and objectivity, resulting in improved diagnostic performance in differentiating gliomas.

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  • Effect of lipiodol marking before CT-guided cryoablation on the outcome of sporadic renal cell carcinoma

    Ushijima, Y; Okamoto, D; Fujita, N; Ishimatsu, K; Wada, N; Takao, S; Murayama, R; Itoyama, M; Ishigami, K

    DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY   30 ( 2 )   117 - 123   2024.3   ISSN:1305-3612

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    PURPOSE This retrospective study evaluates the impact of preoperative lipiodol marking on the outcomes of computed tomography (CT)-guided cryoablation for histologically diagnosed sporadic renal cell carcinoma (RCC). METHODS This study analyzed the data of 173 patients who underwent CT-guided cryoablation for histologi-cally proven sporadic RCC at a single institution between April 2014 and December 2020. The local control rate (LCR), recurrence-free survival rate (RFSR), overall survival rate (OSR), changes in renal function, and complications in patients with (n = 85) and without (n = 88) preoperative lipiodol marking were compared. RESULTS The 5-year LCR and 5-year RFSR were significantly higher in patients with lipiodol marking (97.51% and 93.84%, respectively) than in those without (72.38% and 68.10%, respectively) (P value <0.01, log-rank test). There were no significant differences between the two groups regarding the 5-year OSR (97.50% vs. 86.82%) or the deterioration in chronic kidney disease stage (12.70% vs. 16.43%). Grade ≥3 complications occurred in patients with lipiodol marking (n = 2, retroperitoneal hemato-ma and cerebral infarction in 1 patient each) and without (n = 5; urinary fistula in 2, colonic perfo-ration in 2, urinary infection in 1). CONCLUSION Lipiodol marking before CT-guided cryoablation for sporadic RCC is a feasible approach to improv-ing local control and RFS while mitigating the decline in renal function. Additionally, it may help reduce complications.

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  • Refresher Course 脳神経関連で役立つMRI撮像技術:arterial spin labeling(ASL)

    栂尾 理, 山下 孝二, 菊地 一史, 石神 康生

    画像診断   44 ( 3 )   361 - 373   2024.2   ISSN:02850524 eISSN:24321281

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    DOI: 10.15105/gz.0000005316

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  • Efficacy and Safety of Adjuvant Radiotherapy for Soft Tissue Sarcoma: A Two-Institution Retrospective Observational Study

    Osamu Hisano, Tadamasa Yoshitake, Satoshi Nomoto, Keiji Matsumoto, Hiroaki Wakiyama, Ryuji Uehara, Masanori Takaki, Takeshi Oshima, Yoshihiro Matsumoto, Makoto Endo, Akira Nabeshima, Tomoya Matsunobu, Akira Maekawa, Kousei Ishigami

    SN Comprehensive Clinical Medicine   6 ( 1 )   2024.2   eISSN:2523-8973

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    DOI: 10.1007/s42399-024-01648-8

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  • Improved temporal resolution and acceleration on 4D-MR angiography based on superselective pseudo-continuous arterial spin labeling combined with CENTRA-keyhole and view-sharing (4D-S-PACK) using an interpolation algorithm on the temporal axis and compressed sensing-sensitivity encoding (CS-SENSE). International journal

    Hiroo Murazaki, Tatsuhiro Wada, Osamu Togao, Makoto Obara, Michael Helle, Kouji Kobayashi, Kousei Ishigami, Toyoyuki Kato

    Magnetic resonance imaging   2024.2

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    PURPOSE: Two major drawbacks of 4D-MR angiography based on superselective pseudo-continuous arterial spin labeling combined with CENTRA-keyhole and view-sharing (4D-S-PACK) are the low temporal resolution and long scanning time. We investigated the feasibility of increasing the temporal resolution and accelerating the scanning time on 4D-S-PACK by using CS-SENSE and PhyZiodynamics, a novel image-processing program that interpolates images between phases to generate new phases and reduces image noise. METHODS: Seven healthy volunteers were scanned with a 3.0 T MR scanner to visualize the internal carotid artery (ICA) system. PhyZiodynamics is a novel image-processing that interpolates images between phases to generate new phases and reduces image noise, and by increasing temporal resolution using PhyZiodynamics, inflow dynamic data (reference) were acquired by changing the labeling durations (100-2000 msec, 31 phases) in 4D-S-PACK. From this set of data, we selected seven time intervals to calculate interpolated time points with up to 61 intervals using ×10 for the generation of interpolated phases with PhyZiodynamics. In the denoising process of PhyZiodynamics, we processed the none, low, medium, high noise reduction dataset images. The time intensity curve (TIC), the contrast-to-noise ratio (CNR) were evaluated. In accelerating with CS-SENSE for 4D-S-PACK, 4D-S-PACK were scanned different SENSE or CS-SENSE acceleration factors: SENSE3, CS3-6. Signal intensity (SI), CNR, were evaluated for accelerating the 4D-S-PACK. With regard to arterial vascular visualization, we evaluated the middle cerebral artery (MCA: M1-4 segments). RESULTS: In increasing temporal resolution, the TIC showed a similar trend between the reference dataset and the interpolated dataset. As the noise reduction weight increased, the CNR of the interpolated dataset were increased compared to that of the reference dataset. In accelerating 4D-S-PACK, the SI values of the SENSE3 dataset and CS dataset with CS3-6 were no significant differences. The image noise increased with the increase of acceleration factor, and the CNR decreased with the increase of acceleration factor. Significant differences in CNR were observed between acceleration factor of SENSE3 and CS6 for the M1-4 (P < 0.05). Visualization of small arteries (M4) became less reliable in CS5 or CS6 images. Significant differences were found for the scores of M2, M3 and M4 segments between SENSE3 and CS6. CONCLUSION: With PhyZiodynamics and CS-SENSE in 4D-S-PACK, we were able to shorten the scan time while improving the temporal resolution.

    DOI: 10.1016/j.mri.2024.02.011

  • Efficacy and safety of streptozocin-based chemotherapy for gastroenteropancreatic neuroendocrine tumors in Japanese clinical practice. International journal

    Masatoshi Murakami, Nao Fujimori, Yu Takamatsu, Tetsuhide Ito, Kazuhide Matsumoto, Shotaro Kakehashi, Akihisa Ohno, Katsuhito Teramatsu, Keijiro Ueda, Kousei Ishigami, Yoshihiro Ogawa

    Japanese journal of clinical oncology   2024.2

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    BACKGROUND: Streptozocin has been used to treat neuroendocrine tumors in Europe and the USA; however, its actual status in Japan has not been fully clarified owing to the rarity of this disease and the relatively recent approval of streptozocin in Japan. METHODS: We retrospectively analyzed 53 patients with gastroenteropancreatic neuroendocrine tumors who were treated with streptozocin-based chemotherapy at two Japanese hospitals between January 2004 and June 2023. RESULTS: The overall response and disease control rates were 27.7 and 74.5%, respectively, and the median progression-free survival and overall survival were 7.1 and 20.3 months, respectively. Performance status ≥1 showed a significant negative correlation with progression-free survival, and performance status ≥1 and liver tumor burden ≥25% showed a significant negative correlation with overall survival. No significant differences were observed in the treatment response between pancreatic and gastrointestinal neuroendocrine tumors. No treatment-related serious adverse events were observed; however, 87.7% of patients expressed a decrease in the estimated glomerular filtration rate, which negatively correlated with the duration of streptozocin treatment (r = 0.43, P = 0.0020). In the streptozocin re-administration group (n = 5), no differences were found in efficacy between the initial and second streptozocin treatments. CONCLUSIONS: Although streptozocin is a safe, streptozocin-induced renal dysfunction is a dilemma in streptozocin responders. Streptozocin may benefit patients with gastroenteropancreatic neuroendocrine tumors, especially those with a good performance status; however, in some cases, planned streptozocin withdrawal or switching to other drugs should be considered.

    DOI: 10.1093/jjco/hyae026

  • The cortical high-flow sign of oligodendroglioma, IDH-mutant and 1p/19q-codeleted: comparison between arterial spin labeling and dynamic susceptibility contrast methods. International journal

    Koji Yamashita, Osamu Togao, Kazufumi Kikuchi, Daisuke Kuga, Yuhei Sangatsuda, Yutaka Fujioka, Koji Yoshimoto, Kousei Ishigami

    Neuroradiology   66 ( 2 )   187 - 192   2024.2   ISSN:0028-3940 eISSN:1432-1920

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    PURPOSE: The cortical high-flow sign with the non-enhancing area was reportedly found to be more frequent with oligodendroglioma, IDH-mutant and 1p/19q codeleted (ODG IDHm-codel) than with IDH-wildtype or astrocytoma, IDH-mutant on arterial spin labeling (ASL) in diffuse gliomas. This study aimed to compare the identification rate of the cortical high-flow sign on ASL in patients with ODG IDHm-codel to that on dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI). METHODS: Participants consisted of 32 adult ODG IDHm-codel patients with pathologically confirmed. Subtraction images were generated from paired control and label images on ASL. For DSC, dynamic T2*-weighted perfusion weighted images were obtained after pre-bolus of gadolinium-based contrast agent. Regional cerebral blood flow/volume maps were generated based on the concentration-time curve and arterial input function. Tumor-affecting cortices without contrast enhancement on conventional MR imaging were targeted. The identification rate of the cortical high-flow sign was compared between ASL and DSC using the Pearson's Chi-Square test. RESULTS: Frequency of the cortical high-flow sign was significantly higher on ASL (18/32, 56.3%; p < 0.001) than on DSC (5/32, 15.6%). All cases with the positive cortical high-flow sign on DSC were identified on ASL. CONCLUSION: ASL effectively identifies the cortical high-flow sign in ODG IDHm-codel, surpassing DSC in identification rates.

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  • Transvaginal approach combined intracavitary and interstitial brachytherapy assisted by transrectal ultrasound: results from 30 patients with locally advanced cervical cancer

    Nakashima, T; Matsumoto, K; Yoshitake, T; Wakiyama, H; Hisano, O; Uehara, R; Takaki, M; Oshima, T; Yahata, H; Ishigami, K

    JAPANESE JOURNAL OF RADIOLOGY   42 ( 1 )   96 - 101   2024.1   ISSN:1867-1071 eISSN:1867-108X

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    Purpose: This study evaluated the efficacy and safety of transvaginal approach combined intracavitary and interstitial brachytherapy (IC/IS BT) assisted by transrectal ultrasound (TRUS) for treatment of locally advanced cervical cancer (LACC). Materials and Methods: A total of 30 patients of LACC treated with external beam radiotherapy and IC/IS BT via transvaginal approach assisted by transrectal ultrasound were observed retrospectively. The 2-year local control (LC), progression-free survival (PFS), and overall survival (OS) were analyzed using the Kaplan–Meier method. Late adverse events were also evaluated to assess the safety of IC/IS BT. Results: The median follow-up period was 22 months. The 2-year LC, PFS, and OS were 90%, 61%, and 82%, respectively. We observed no critical complications related to the IC/IS BT technique. Late adverse events of grade 3 or more included one case of grade 4 colon perforation. Conclusion: Our patient series demonstrated that radiotherapy combined with transvaginal approach, TRUS-assisted IC/IS BT achieves favorable local control and safety for LACC.

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  • 特集 非典型症例と類似疾患を知ってCommon Diseaseを極める 3 腹部 ⑰ 消化器▶消化管

    鶴丸 大介, 西牟田 雄祐, 南條 勝哉, 石神 康生

    臨床放射線   68 ( 12 )   1273 - 1277   2023.12   ISSN:00099252

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    DOI: 10.18888/rp.0000002549

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  • Incidence and severity of pulmonary embolism in COVID-19 infection: Ancestral, Alpha, Delta, and Omicron variants

    Wada, N; Li, Y; Gagne, S; Hino, T; Valtchinov, VI; Gay, E; Nishino, M; Hammer, MM; Madore, B; Guttmann, CRG; Ishigami, K; Hunninghake, GM; Levy, BD; Kaye, KM; Christiani, DC; Hatabu, H

    MEDICINE   102 ( 48 )   e36417   2023.12   ISSN:0025-7974 eISSN:1536-5964

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    Little information is available regarding incidence and severity of pulmonary embolism (PE) across the periods of ancestral strain, Alpha, Delta, and Omicron variants. The aim of this study is to investigate the incidence and severity of PE over the dominant periods of ancestral strain and Alpha, Delta, and Omicron variants. We hypothesized that the incidence and the severity by proximity of PE in patients with the newer variants and vaccination would be decreased compared with those in ancestral and earlier variants. Patients with COVID-19 diagnosis between March 2020 and February 2022 and computed tomography pulmonary angiogram performed within a 6-week window around the diagnosis (-2 to +4 weeks) were studied retrospectively. The primary endpoints were the associations of the incidence and location of PE with the ancestral strain and each variant. Of the 720 coronavirus disease 2019 patients with computed tomography pulmonary angiogram (58.6 ± 17.2 years; 374 females), PE was diagnosed among 42/358 (12%) during the ancestral strain period, 5/60 (8%) during the Alpha variant period, 16/152 (11%) during the Delta variant period, and 13/150 (9%) during the Omicron variant period. The most proximal PE (ancestral strain vs variants) was located in the main/lobar arteries (31% vs 6%-40%), in the segmental arteries (52% vs 60%-75%), and in the subsegmental arteries (17% vs 0%-19%). There was no significant difference in both the incidence and location of PE across the periods, confirmed by multivariable logistic regression models. In summary, the incidence and severity of PE did not significantly differ across the periods of ancestral strain and Alpha, Delta, and Omicron variants.

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  • Reproducibility of quantitative ADC, T1, and T2 measurement on the cerebral cortex: Utility of whole brain echo-planar DWI with compressed SENSE (EPICS-DWI): A pilot study. International journal

    Koji Yamashita, Masami Yoneyama, Kazufumi Kikuchi, Tatsuhiro Wada, Hiroo Murazaki, Hiroaki Watanuki, Ryoji Mikayama, Kousei Ishigami, Osamu Togao

    European journal of radiology open   11   100516 - 100516   2023.12

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    PURPOSE: To assess the reproducibility of ADC, T1, T2, and proton density (PD) measurements on the cortex across the entire brain using high-resolution pseudo-3D diffusion-weighted imaging using echo-planar imaging with compressed SENSE (EPICS-DWI) and 3D quantification with an interleaved Look-Locker acquisition sequence with T2 preparation pulse (3D-QALAS) in normal healthy adults. METHODS: Twelve healthy participants (median age, 33 years; range, 28-51 years) were recruited to evaluate the reproducibility of whole-brain EPICS-DWI and synthetic MRI. EPICS-DWI utilizes a compressed SENSE reconstruction framework while maintaining the EPI sampling pattern. The 3D-QALAS sequence is based on multi-acquisition 3D gradient echo, with five acquisitions equally spaced in time, interleaved with a T2 preparation pulse and an inversion pulse. EPICS-DWI (b values, 0 and 1000 s/mm2) and 3D-QALAS sequence with identical voxel size on a 3.0-T MR system were performed twice (for test-retest scan). Intraclass correlation coefficients (ICCs) for ADC, T1, T2, and PD for all parcellated volume of interest (VOI) per subject on scan-rescan tests were calculated to assess reproducibility. Bland-Altman plots were used to investigate discrepancies in ADCs, T1s, T2s, and PDs obtained from the two MR scans. RESULTS: The ICC of ADCs was 0.785, indicating "good" reproducibility. The ICCs of T1s, T2s, and PDs were 0.986, 0.978, and 0.968, indicating "excellent" reproducibility. CONCLUSION: The combination of EPICS-DWI and 3D-QALAS sequences with identical voxel size could reproducible ADC, T1, T2, and PD measurements for the cortex across the entire brain in healthy adults.

    DOI: 10.1016/j.ejro.2023.100516

  • Diagnostic MR imaging features of hypomyelination of early myelinating structures: A case report. International journal

    Tokiko Abe, Koji Yamashita, Kazufumi Kikuchi, Eriko Hatai, Fumihiko Fujii, Pin Fee Chong, Yasunari Sakai, Hirotomo Saitsu, Ken Inoue, Osamu Togao, Kousei Ishigami

    The neuroradiology journal   19714009231224419 - 19714009231224419   2023.12

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    Hypomyelination of early myelinating structures (HEMS) has recently been defined as a new genetic disorder accompanied by clinical and MR imaging characteristics. However, no studies have focused on diffusion-weighted imaging (DWI) findings of HEMS. We would like to propose a "sheep sign," which is formed by DWI hyperintensity in the medial medullary lamina along with alternating high-low-high (HLH) intensity stripes in the posterior limb of the internal capsule. We believe the presence of the "sheep sign" on DWI in combination with alternating HLH intensity stripes may be a valuable tool for diagnosing HEMS.

    DOI: 10.1177/19714009231224419

  • Clinical significance of dual-energy dual-layer CT parameters in differentiating small-sized gastrointestinal stromal tumors from leiomyomas.

    Daisuke Tsurumaru, Yusuke Nishimuta, Satohiro Kai, Eiji Oki, Yosuke Minoda, Kousei Ishigami

    Japanese journal of radiology   41 ( 12 )   1389 - 1396   2023.12   ISSN:1867-1071 eISSN:1867-108X

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    PURPOSE: Small gastrointestinal stromal tumors (GISTs) can generally have nonspecific CT findings similar to those with benign submucosal tumors of the stomach. The purpose of this study was to explore the potential dual-layer dual-energy CT (dlDECT) parameters to differentiate small-sized (≤ 4 cm) GISTs from leiomyomas of the stomach. MATERIALS AND METHODS: This retrospective study included 26 SMTs ≤ 4 cm in diameter with pathological confirmation of either GIST (n = 17) or leiomyoma (n = 9) from May 2018 to January 2022. All patients received contrast-enhanced CT. The normalized iodine concentration (NIC) and spectral slope (λHU) were compared between GIST and leiomyoma. Receiver-operating characteristic (ROC) curves were plotted and the areas under the curve (AUCs) were calculated to estimate the diagnostic performance of these markers for differentiating GISTs from leiomyomas. RESULTS: NIC was significantly higher in GIST than in leiomyoma in the portal (P = 0.0019) and delayed phases (P = 0.0011). λHU was significantly higher in GIST than in leiomyoma in the portal (P = 0.0006) and delayed phases (P = 0.0009). AUC of the ROC curves using NIC to differentiate between GIST and leiomyoma were 0.875 and 0.895 in the portal and delayed phase; using λHU, they were 0.918 and 0.902 in the portal and delayed phase. CONCLUSION: dlDECT parameters including NIC and λHU show promise as indicators for differentiating small-sized GISTs from leiomyomas.

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  • 特集 全身の血栓症・塞栓症を考える 肺動脈血栓症・塞栓症

    山崎 誘三, 神谷 武志, 鷺山 幸二, 日野 卓也, 田畑 公佑, 木佐貫 恵, 藪内 英剛, 石神 康生

    画像診断   43 ( 14 )   1379 - 1389   2023.11   ISSN:02850524 eISSN:24321281

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    DOI: 10.15105/gz.0000005005

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  • Refined scan protocol for the evaluation of pulmonary perfusion standardized image quality and reduced radiation dose in dynamic chest radiography. International journal

    Kenta Takakura, Yuzo Yamasaki, Taku Kuramoto, Satoshi Yoshidome, Tomoyuki Hida, Takeshi Kamitani, Hideki Yoshikawa, Toyoyuki Kato, Kousei Ishigami

    Journal of applied clinical medical physics   e14222   2023.11

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    PURPOSE: Dynamic chest radiography (DCR) is a novel imaging technique used to noninvasively evaluate pulmonary perfusion. However, the standard DCR protocol, which is roughly adapted to the patient's body size, occasionally causes over- or underexposure, which could influence clinical evaluation. Therefore, we proposed a refined protocol by increasing the number of patient body mass index (BMI) categories from three to seven groups and verified its usefulness by comparing the image sensitivity indicators (S-values) and entrance surface doses (ESDs) of the conventional protocol with those of our refined protocol. METHODS: This retrospective observational study included 388 datasets (standing position, 224; supine position, 164) for the conventional protocol (December 2019-April 2021) and 336 datasets (standing position, 233; supine position, 103) for the refined protocol (June-November 2021). The conventional protocol (BMI-3 protocol) divided the patients into three BMI groups (BMI < 17, 17≤BMI < 25, and BMI ≥ 25 kg/m2 ), whereas the refined protocol (BMI-7 protocol) divided the patients into seven BMI groups (BMI < 17, 17 ≤ BMI < 20, 20 ≤ BMI < 23, 23 ≤ BMI < 26, 26 ≤ BMI < 29, 29 ≤ BMI < 32, and BMI ≥ 32 kg/m2 ). The coefficients of variation (CVs) for the S-values and ESDs acquired using the two protocols were compared. RESULTS: The CVs of the S-values in the BMI-7 protocol group were significantly lower than those in the BMI-3 protocol group for the standing (28.8% vs. 16.7%; p < 0.01) and supine (24.5% vs. 17.7%; p < 0.01) positions. The ESDs of patients scanned using the BMI-7 protocol were significantly lower than those scanned using the BMI-3 protocol in the standing (1.3 vs. 1.1 mGy; p < 0.01) and supine positions (2.5 vs. 1.6 mGy; p < 0.01), although the mean BMI of the two groups were similar. CONCLUSION: We introduced the BMI-7 protocol and demonstrated its standardized image quality and reduced radiation exposure in patients undergoing DCR.

    DOI: 10.1002/acm2.14222

  • Arterial Spin Labeling-Based MR Angiography for Cerebrovascular Diseases: Principles and Clinical Applications. International journal

    Osamu Togao, Makoto Obara, Koji Yamashita, Kazufumi Kikuchi, Tatsuhiro Wada, Hiroo Murazaki, Koichi Arimura, Ataru Nishimura, Nobutaka Horie, Kim van de Ven, Marc Van Cauteren, Kousei Ishigami

    Journal of magnetic resonance imaging : JMRI   2023.11

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    Arterial spin labeling (ASL) is a noninvasive imaging technique that labels the proton spins in arterial blood and uses them as endogenous tracers. Brain perfusion imaging with ASL is becoming increasingly common in clinical practice, and clinical applications of ASL for intracranial magnetic resonance angiography (MRA) have also been demonstrated. Unlike computed tomography (CT) angiography and cerebral angiography, ASL-based MRA does not require contrast agents. ASL-based MRA overcomes most of the disadvantages of time-of-flight (TOF) MRA. Several schemes have been developed for ASL-based MRA; the most common method has been pulsed ASL, but more recently pseudo-continuous ASL, which provides a higher signal-to-noise ratio (SNR), has been used more frequently. New methods that have been developed include direct intracranial labeling methods such as velocity-selective ASL and acceleration-selective ASL. MRA using an extremely short echo time (eg, silent MRA) or ultrashort echo-time (TE) MRA can suppress metal susceptibility artifacts and is ideal for patients with a metallic device implanted in a cerebral vessel. Vessel-selective 4D ASL MRA can provide digital subtraction angiography (DSA)-like images. This review highlights the principles, clinical applications, and characteristics of various ASL-based MRA techniques. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.

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  • Combination of Clinical Factors and Radiomics Can Predict Local Recurrence and Metastasis After Stereotactic Body Radiotherapy for Non-small Cell Lung Cancer

    Isoyama-Shirakawa, Y; Yoshitake, T; Ninomiya, K; Asai, K; Matsumoto, K; Shioyama, Y; Kodama, T; Ishigami, K; Arimura, H

    ANTICANCER RESEARCH   43 ( 11 )   5003 - 5013   2023.11   ISSN:0250-7005 eISSN:1791-7530

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    Background/Aim: Radiomics, which links radiological image features with patient prognoses, is expected to be applied for the prediction of the clinical outcomes of radiotherapy. We investigated the clinical and radiomic factors associated with recurrence patterns after stereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC). Patients and Methods: We retrospectively analyzed 125 patients with histologically confirmed NSCLC who underwent SBRT between April 2003 and June 2017 at our institution. A radiomic score was calculated from five radiomics features (histogram and texture features) selected using the LASSO Cox regression model. These features were extracted from the gross tumor volume (GTV) in three-dimensional wavelet decomposition CT images. We used univariate and multivariate analyses to determine the associations between local control (LC) time and metastasis-free survival (MFS), clinical factors (age, sex, performance status, operability, smoking, histology, and tumor diameter), and the radiomic score. Results: With a median follow-up of 37 months, the following 3-year rates were observed: overall survival, 80.9%; progression-free survival, 61.7%; LC, 75.1%, and MFS; 74.5%. In multivariate analysis, histology (squamous cell carcinoma vs. non-squamous cell carcinoma, p=0.0045), tumor diameter (>3 cm vs. ≤3 cm, p=0.039); and radiomic score (>0.043 vs. ≤0.043, p=0.042) were significantly associated with LC, and the radiomic score (>0.304 vs. ≤0.304, p<0.001) was significantly associated with MFS. Conclusion: Histology, tumor diameter, and radiomic score could be significant factors for predicting NSCLC recurrence patterns after SBRT.

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  • Diagnostic accuracy of percutaneous core biopsy before cryoablation for small-sized renal cell carcinoma

    Ushijima, Y; Nishie, A; Fujita, N; Kubo, Y; Ishimatsu, K; Ishigami, K

    DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY   29 ( 6 )   800 - 804   2023.11   ISSN:1305-3612

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    PURPOSE To retrospectively determine the diagnostic accuracy of a percutaneous core biopsy performed before cryoablation for small-sized renal cell carcinoma. METHODS In this study, 216 patients underwent a percutaneous core biopsy for 242 renal lesions suspected to be renal cell carcinoma on image findings before cryoablation at Kyushu University Hospital. We calculated the success rate of the histological diagnosis and investigated factors that may have contributed to the diagnostic success. Complications caused by the biopsy procedure were also evaluated. RESULTS The histological diagnosis was successful in 203 lesions (82.8%). The success rate of the histologi-cal diagnosis was 65.4% (34/52 cases) for tumors with a diameter of ≤15 mm and 88.9% (169/190 cases) for those >15 mm. Therefore, tumor diameter was a factor contributing to the histological diagnosis success rate in both univariate and multivariable analyses (P < 0.001). For lesions with a tumor diameter ≤15 mm, the histological diagnosis success rates increased from 50.0% to 76.2% in the presence of pre-lipiodol marking and to 85.7% when the biopsy procedure was performed separately from cryoablation; the latter was statistically significant (P = 0.039). Major complications that may have been caused by the biopsy procedure were grade 3 bleeding and tract seeding (one case each). CONCLUSION Percutaneous core biopsy in cryoablation for small-sized renal cell carcinoma had a high diagnostic rate and was safely performed. For lesions with a tumor diameter ≤15 mm, a separate biopsy procedure and pre-lipiodol marking may improve the diagnostic accuracy.

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  • Correction to: Cortical high‑flow sign on arterial spin labeling: a novel biomarker for IDH‑mutation and 1p/19q‑codeletion status in diffuse gliomas without intense contrast enhancement. International journal

    Koji Yamashita, Osamu Togao, Kazufumi Kikuchi, Daisuke Kuga, Yuhei Sangatsuda, Yutaka Fujioka, Izumi Kinoshita, Makoto Obara, Koji Yoshimoto, Kousei Ishigami

    Neuroradiology   65 ( 11 )   1675 - 1676   2023.11   ISSN:0028-3940 eISSN:1432-1920

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    The original article contains an error during online publication. There was an error in the previous version of Table 2. Specifically, the values of rrTBF for IDHm-noncodel and IDHm-codel were identical at 1.24 ± 1.23 [0.76–1.71]. The authors have provided a corrected version below. (Table presented.) Differences between IDHw, IDHm-noncodel and IDHm-codel in the ASL parameters IDHw (n = 21) IDHm-noncodel (n = 28) IDHm-codel (n = 22) P-value ASL Cortical high-flow sign 2/21(9.5%) 2/28(7.1%) 12/22(54.5%) <0.0001* rrTBF 1.31 ± 0.56 [1.05–1.56] 1.24 ± 1.23 [0.76–1.71] 1.31 ± 0.60 [1.05–1.58] 0.9473 *p < 0.05

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  • Prognostic Impact of Preoperative Osteosarcopenia for Patients with Pancreatic Ductal Adenocarcinoma After Curative Resection

    Abe, T; Nakata, K; Nakamura, S; Ideno, N; Ikenaga, N; Fujita, N; Ishigami, K; Nishihara, K; Nakamura, M

    ANNALS OF SURGICAL ONCOLOGY   30 ( 11 )   6673 - 6679   2023.10   ISSN:1068-9265 eISSN:1534-4681

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    Backgrounds: The clinical significance of preoperative osteosarcopenia in pancreatic ductal adenocarcinoma (PDAC) has not been fully studied. The purpose of this study was to evaluate the role of preoperative osteosarcopenia in predicting the survival of patients with PDAC. Methods: We retrospectively analyzed 265 patients who underwent curative surgical resection for PDAC between 2012 and 2018 in two Japanese institutes. The skeletal muscle index at the L3 vertebrae and the bone mineral density at the Th11 vertebra were calculated for the evaluation of osteosarcopenia before surgery. The relationship between perioperative osteosarcopenia and clinicopathological factors and prognosis was analyzed. Results: The median overall survival (OS) and disease-free survival (DFS) of patients with osteosarcopenia were significantly shorter than those of patients without osteosarcopenia (OS: 23 and 48 months, respectively, P < 0.001; DFS: 13.4 and 21.2 months, respectively, P = 0.004). On multivariate analysis, osteosarcopenia was found to be an independent factor associated with OS (hazard ratio [HR] 1.98; 95% confidence interval [CI] 1.40–2.80; P < 0.001) and DFS (HR 1.53; 95% CI 1.11–2.10; P = 0.009). Conclusions: Preoperative osteosarcopenia may be a useful prognostic factor in patients with PDAC who undergo surgical resection. Further studies are needed to assess whether perioperative, nutritional interventions and rehabilitation contribute to improving the prognosis of these patients.

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  • 特集 癌治療後の局所再発と転移の画像診断 6. 胃

    鶴丸 大介, 西牟田 雄祐, 甲斐 聖広, 石神 康生

    画像診断   43 ( 11 )   A76 - A84   2023.9   ISSN:02850524 eISSN:24321281

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    DOI: 10.15105/gz.0000004836

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  • Impact of portal-phase signal intensity of dynamic gadoxetic acid-enhanced magnetic resonance imaging in hepatocellular carcinoma

    Takahiro Tomino, Shinji Itoh, Daisuke Okamoto, Shohei Yoshiya, Yoshihiro Nagao, Noboru Harada, Nobuhiro Fujita, Yasuhiro Ushijima, Kousei Ishigami, Tomoharu Yoshizumi

    Journal of Hepato-Biliary-Pancreatic Sciences   30 ( 9 )   1089 - 1097   2023.9   ISSN:1868-6974 eISSN:1868-6982

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    Purpose: To evaluate the prognostic impact of dynamic gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) in patients with hepatocellular carcinoma (HCC). Methods: We retrospectively reviewed the data of 206 patients with HCC who underwent preoperative Gd-EOB-DTPA-enhanced MRI and hepatectomy and quantitatively evaluated the signal intensity ratio of the tumor to the surrounding liver tissue in the portal phase (SIRPP). We verified the survival rates and assessed the prognostic factors associated with overall survival (OS) and recurrence-free survival (RFS) using SIRPP. Results: Multivariate analysis revealed that the independent predictive factors for poorly-differentiated HCC were α-fetoprotein > 20 ng/mL (hazard ratio [HR]: 3.1909, 95% confidence interval [CI]: 1.3464–7.5622, p =.0084) and SIRPP ≤ 0.85 (HR: 3.7155, 95% CI: 1.521–9.076, p =.004). The 5-year OS and RFS rates in the high and low SIRPP groups were 83.2 and 52.1%, respectively (p <.0001) and 49.7 and 18.5%, respectively (p =.0003). Multivariate analysis revealed that SIRPP ≤ 0.68 was an independent prognostic factor related to OS (HR: 4.4537, 95% CI: 1.6581–11.9626, p =.003). Conclusion: The SIRPP of preoperative Gd-EOB-DTPA-enhanced MRI might predict the histological differentiation and prognosis of HCC.

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  • Cortical high-flow sign on arterial spin labeling: a novel biomarker for IDH-mutation and 1p/19q-codeletion status in diffuse gliomas without intense contrast enhancement. International journal

    Koji Yamashita, Osamu Togao, Kazufumi Kikuchi, Daisuke Kuga, Yuhei Sangatsuda, Yutaka Fujioka, Izumi Kinoshita, Makoto Obara, Koji Yoshimoto, Kousei Ishigami

    Neuroradiology   65 ( 9 )   1415 - 1418   2023.9   ISSN:0028-3940 eISSN:1432-1920

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    This study aimed to investigate whether arterial spin labeling (ASL) features allow differentiation of oligodendroglioma, IDH-mutant and 1p/19q-codeleted (IDHm-codel) from diffuse glioma with IDH-wildtype (IDHw) or astrocytoma, IDH-mutant (IDHm-noncodel). Participants comprised 71 adult patients with pathologically confirmed diffuse glioma, classified as IDHw, IDHm-noncodel, or IDHm-codel. Subtraction images were generated from paired-control/label images on ASL and used to assess the presence of a cortical high-flow sign. The cortical high-flow sign was defined as increased ASL signal intensity within the tumor-affecting cerebral cortex compared with normal-appearing cortex. Regions without contrast enhancement on conventional MR imaging were targeted. The frequency of the cortical high-flow sign on ASL was compared among IDHw, IDHm-noncodel, and IDHm-codel. As a result, the frequency of the cortical high-flow sign was significantly higher for IDHm-codel than for IDHw or IDHm-noncodel. In conclusion, the cortical high-flow sign could represent a hallmark of oligodendroglioma, IDH-mutant, and 1p/19q-codeleted without intense contrast enhancement.

    DOI: 10.1007/s00234-023-03186-x

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  • Dynamic chest radiography for pulmonary vascular diseases: clinical applications and correlation with other imaging modalities.

    Yuzo Yamasaki, Takeshi Kamitani, Koji Sagiyama, Takuya Hino, Megumi Kisanuki, Kosuke Tabata, Takuro Isoda, Yoshiyuki Kitamura, Kohtaro Abe, Kazuya Hosokawa, Daisuke Toyomura, Shohei Moriyama, Masateru Kawakubo, Hidetake Yabuuchi, Kousei Ishigami

    Japanese journal of radiology   2023.8

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    Dynamic chest radiography (DCR) is a novel functional radiographic imaging technique that can be used to visualize pulmonary perfusion without using contrast media. Although it has many advantages and clinical utility, most radiologists are unfamiliar with this technique because of its novelty. This review aims to (1) explain the basic principles of lung perfusion assessment using DCR, (2) discuss the advantages of DCR over other imaging modalities, and (3) review multiple specific clinical applications of DCR for pulmonary vascular diseases and compare them with other imaging modalities.

    DOI: 10.1007/s11604-023-01483-2

  • The Feasibility of Deep Learning-Based Reconstruction for Low-Tube-Voltage CT Angiography for Transcatheter Aortic Valve Implantation. International journal

    Tsukasa Kojima, Yuzo Yamasaki, Yuko Matsuura, Ryoji Mikayama, Takashi Shirasaka, Masatoshi Kondo, Takeshi Kamitani, Toyoyuki Kato, Kousei Ishigami, Hidetake Yabuuchi

    Journal of computer assisted tomography   2023.8

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    OBJECTIVE: The purpose of this study is to evaluate the efficacy of deep learning reconstruction (DLR) on low-tube-voltage computed tomographic angiography (CTA) for transcatheter aortic valve implantation (TAVI). METHODS: We enrolled 30 patients who underwent TAVI-CT on a 320-row CT scanner. Electrocardiogram-gated coronary CTA (CCTA) was performed at 100 kV, followed by nongated aortoiliac CTA at 80 kV using a single bolus of contrast material. We used hybrid-iterative reconstruction (HIR), model-based IR (MBIR), and DLR to reconstruct these images. The contrast-to-noise ratios (CNRs) were calculated. Five-point scales were used for the overall image quality analysis. The diameter of the aortic annulus was measured in each reconstructed image, and we compared the interobserver and intraobserver agreements. RESULTS: In the CCTA, the CNR and image quality score for DLR were significantly higher than those for HIR and MBIR (P < 0.01). In the aortoiliac CTA, the CNR for DLR was significantly higher than that for HIR (P < 0.01) and significantly lower than that for MBIR (P ≤ 0.02). The image quality score for DLR was significantly higher than that for HIR (P < 0.01). No significant differences were observed between the image quality scores for DLR and MBIR. The measured aortic annulus diameter had high interobserver and intraobserver agreement regardless of the reconstruction method (all intraclass correlation coefficients, >0.89). CONCLUSIONS: In low tube voltage TAVI-CT, DLR provides higher image quality than HIR, and DLR provides higher image quality than MBIR in CCTA and is visually comparable to MBIR in aortoiliac CTA.

    DOI: 10.1097/RCT.0000000000001525

  • Predicting TERT promoter mutation status using 1H-MR spectroscopy and stretched-exponential model of diffusion-weighted imaging in IDH-wildtype diffuse astrocytic glioma without intense enhancement. International journal

    Koji Yamashita, Ryusuke Hatae, Kazufumi Kikuchi, Daisuke Kuga, Nobuhiro Hata, Hidetaka Yamamoto, Makoto Obara, Koji Yoshimoto, Kousei Ishigami, Osamu Togao

    Neuroradiology   65 ( 8 )   1205 - 1213   2023.8

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    PURPOSE: Isocitrate dehydrogenase (IDH)-wildtype diffuse astrocytic glioma with telomerase reverse transcriptase (TERT) promoter mutation is defined as glioblastoma by the WHO 2021 criteria, revealing that TERT promotor mutation is highly associated with tumor aggressiveness. The aim of this study was to identify features from MR spectroscopy (MRS) and multi-exponential models of DWI distinguishing wild-type TERT (TERTw) from TERT promoter mutation (TERTm) in IDH-wildtype diffuse astrocytic glioma. METHODS: Participants comprised 25 adult patients with IDH-wildtype diffuse astrocytic glioma. Participants were classified into TERTw and TERTm groups. Point-resolved spectroscopy sequences were used for MRS data acquisition. DWI was performed with 13 different b-factors. Peak height ratios of NAA/Cr and Cho/Cr were calculated from MRS data. Mean apparent diffusion coefficient (ADC), perfusion fraction (f), diffusion coefficient (D), pseudo-diffusion coefficient (D*), distributed diffusion coefficient (DDC), and heterogeneity index (α) were obtained using multi-exponential models from DWI data. Each parameter was compared between TERTw and TERTm using the Mann-Whitney U test. Correlations between parameters derived from MRS and DWI were also evaluated. RESULTS: NAA/Cr and Cho/Cr were both higher for TERTw than for TERTm. The α of TERTw was smaller than that of TERTm, while the f of TERTw was higher than that of TERTm. NAA/Cr correlated negatively with α, but not with other DWI parameters. Cho/Cr did not show significant correlations with any DWI parameters. CONCLUSION: The combination of NAA/Cr and α may have merit in clinical situation to predict the TERT mutation status of IDH-wildtype diffuse astrocytic glioma without intense enhancement.

    DOI: 10.1007/s00234-023-03177-y

  • 特集1 令和にアップデートしたい 膵癌の画像診断 撮像法

    石松 慶祐, 藤田 展宏, 石神 康生

    臨床画像   39 ( 7 )   730 - 737   2023.7   ISSN:09111069

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    DOI: 10.18885/ci.0000001341

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  • Gyrification of the medial and lateral orbitofrontal cortex in first-degree relatives of patients with obsessive-compulsive disorder. International journal

    Hirofumi Tomiyama, Keitaro Murayama, Kiyotaka Nemoto, Kenta Kato, Akira Matsuo, Aikana Ohno, Mingi Kang, Osamu Togao, Kousei Ishigami, Tomohiro Nakao

    Cerebral cortex (New York, N.Y. : 1991)   33 ( 14 )   8913 - 8920   2023.7

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    Gyrification patterns reflect early neurodevelopment and could be highly heritable. While some discrepant results have been reported, the most consistent finding was that patients with obsessive-compulsive disorder showed altered gyrification patterns in the orbitofrontal cortex. Nevertheless, no study has investigated the alterations in gyrification in unaffected first-degree relatives of patients with obsessive-compulsive disorder. We measured local gyrification by the FreeSurfer software in 23 unaffected first-degree relatives of patients with obsessive-compulsive disorder and 52 healthy control participants. We explored differences in the local gyrification index using vertex-wise whole-brain analysis and a region of interest-based approach in the medial and lateral orbitofrontal cortex. There was no significant difference in the local gyrification index between the 2 groups in the vertex-wise whole-brain analysis. Region of interest analyses showed that, compared with healthy controls, first-degree relatives showed significantly reduced local gyrification index in the left medial and lateral orbitofrontal cortex. A negative correlation was observed between the reduced local gyrification index in lateral orbitofrontal cortex and the subclinical anxiety scores of first-degree relatives. Our results showed that first-degree relatives of patients with obsessive-compulsive disorder had an altered local gyrification index in the orbitofrontal cortex. Especially, reduced local gyrification index in lateral orbitofrontal cortex associated with subclinical anxiety symptom could be a potential neurodevelopmental marker for the illness onset.

    DOI: 10.1093/cercor/bhad170

  • Extracellular volume fraction determined by equilibrium contrast-enhanced computed tomography: correlation with histopathological findings in gastric cancer.

    Yusuke Nishimuta, Daisuke Tsurumaru, Satohiro Kai, Junki Maehara, Yoshiki Asayama, Eiji Oki, Kousei Ishigami

    Japanese journal of radiology   41 ( 7 )   752 - 759   2023.7

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    PURPOSE: To assess the relationship between histopathological features of gastric cancer and the extracellular volume fraction (ECV) measured by preoperative equilibrium contrast-enhanced computed tomography (CECT). MATERIALS AND METHODS: The study group consisted of 66 patients with surgically resected gastric adenocarcinoma who underwent preoperative multiphasic CECT. Tumor ECVs were calculated using region-of-interest measurements within the gastric cancer and aorta of each case on unenhanced and equilibrium-phase images. The relationship between the mean ECV values and clinicopathological parameters was examined by univariate analysis. Parameters showing a significant difference in the former test were further tested by linear regression and receiver operating characteristic (ROC) curve analyses. RESULTS: In the univariate analysis, the values of venous invasion (p = 0.0487) and tumor infiltration (INF) pattern (p < 0.0001) were significantly correlated with the tumor ECV. INF was significantly correlated (β = 0.57, p < 0.0001) in the linear regression analysis. The tumor ECV showed better diagnostic accuracy for predicting INF (INFa/b vs INFc), and the area under the ROC curve value was 0.89. CONCLUSION: Tumor ECV determined by equilibrium CECT is significantly correlated with the pathological INF of gastric cancer.

    DOI: 10.1007/s11604-023-01393-3

  • 特集1 絶対苦手分野にしない 成人先天性心疾患の画像診断 Fallot四徴症

    山崎 誘三, 神谷 武志, 石神 康生

    臨床画像   39 ( 6 )   614 - 621   2023.6   ISSN:09111069

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    DOI: 10.18885/ci.0000001311

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  • The T2-FLAIR mismatch sign in glioblastoma, isocitrate dehydrogenase wild-type A case report. International journal

    Shunsuke Nishimura, Koji Yamashita, Osamu Togao, Kazufumi Kikuchi, Daisuke Kuga, Hidetaka Yamamoto, Koji Yoshimoto, Kousei Ishigami

    Acta radiologica open   12 ( 6 )   20584601231184565 - 20584601231184565   2023.6

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    We present a case of the T2-FLAIR mismatch sign in glioblastoma, isocitrate dehydrogenase (IDH)-wild type. The T2-FLAIR mismatch sign is known as a highly specific imaging finding of astrocytoma, IDH-mutant. Meanwhile, IDH-wildtype diffuse astrocytic gliomas with telomerase reverse transcriptase (TERT) promoter mutation in adults are defined as glioblastoma in the 2021 World Health Organization Classification of Tumors of the Central Nervous System, fifth edition (2021 WHO classification), which underscores the importance of molecular information in central nervous system tumors. This indicates even glioblastoma, IDH-wild type may be masquerading as lower-grade glioma in histology. The reasons for the discrepancy between tumors with less aggressive histology and poor prognosis caused by telomerase reverse transcriptase promoter mutation of IDH-wildtype diffuse glioma remain unclear. However, glioblastoma, IDH-wildtype should be considered as a potential differential diagnosis even in patients with the T2-FLAIR mismatch sign in diffuse gliomas.

    DOI: 10.1177/20584601231184565

  • Functional connectivity between pre-supplementary motor area and inferior parietal lobule associated with impaired motor response inhibition in first-degree relatives of patients with obsessive-compulsive disorder. International journal

    Hirofumi Tomiyama, Keitaro Murayama, Kiyotaka Nemoto, Mayumi Tomita, Kenta Kato, Akira Matsuo, Aikana Ohno, Mingi Kang, Osamu Togao, Kousei Ishigami, Tomohiro Nakao

    Cerebral cortex (New York, N.Y. : 1991)   33 ( 12 )   7531 - 7539   2023.6

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    Previous studies have suggested that specific fronto-striatal circuits are associated with impaired motor response inhibition in patients with obsessive-compulsive disorder (OCD) and their relatives. However, no study has investigated the underlying resting-state network associated with motor response inhibition in the unaffected first-degree relatives of patients with OCD. We measured motor response inhibition using stop-signal task, and obtained resting-state fMRI in 23 first-degree relatives and 52 healthy control participants. We explored the group differences in the functional network from seed regions-of-interest (ROIs) associated with motor response inhibition abilities. We used the inferior frontal gyrus (IFG) and pre-supplementary motor area (pre-SMA) as seed-ROIs. A significant group difference was observed in functional connectivity between the pre-SMA and inferior parietal lobule. In the relative group, reduced functional connectivity between these areas was associated with a longer stop-signal reaction time. Additionally, relatives showed significantly greater functional connectivity between the IFG and SMA, precentral, and postcentral areas. Our results could provide new insights into the resting-state neural activity of the pre-SMA underlying impaired motor response inhibition of unaffected first-degree relatives. In addition, our results suggested that relatives have an altered connectivity of the sensorimotor region, similar to that of patients with OCD shown in previous literature.

    DOI: 10.1093/cercor/bhad058

  • Posterior cingulate cortex spontaneous activity associated with motor response inhibition in patients with obsessive-compulsive disorder: A resting-state fMRI study

    Hirofumi Tomiyama, Keitaro Murayama, Kiyotaka Nemoto, Mayumi Tomita, Suguru Hasuzawa, Taro Mizobe, Kenta Kato, Akira Matsuo, Aikana Ohno, Minji Kan, Osamu Togao, Akio Hiwatashi, Kousei Ishigami, Tomohiro Nakao

    Psychiatry Research: Neuroimaging   111669 - 111669   2023.6

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    DOI: 10.1016/j.pscychresns.2023.111669

  • Machine learning-based model for prediction and feature analysis of recurrence in pancreatic neuroendocrine tumors G1/G2.

    Masatoshi Murakami, Nao Fujimori, Kohei Nakata, Masafumi Nakamura, Shinichi Hashimoto, Hiroshi Kurahara, Kazuyoshi Nishihara, Toshiya Abe, Shunpei Hashigo, Naotaka Kugiyama, Eisuke Ozawa, Kazuhisa Okamoto, Yusuke Ishida, Keiichi Okano, Ryo Takaki, Yutaka Shimamatsu, Tetsuhide Ito, Masami Miki, Noriko Oza, Daisuke Yamaguchi, Hirofumi Yamamoto, Hironobu Takedomi, Ken Kawabe, Tetsuro Akashi, Koichi Miyahara, Jiro Ohuchida, Yasuhiro Ogura, Yohei Nakashima, Toshiharu Ueki, Kousei Ishigami, Hironobu Umakoshi, Keijiro Ueda, Takamasa Oono, Yoshihiro Ogawa

    Journal of gastroenterology   58 ( 6 )   586 - 597   2023.6

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    BACKGROUND: Pancreatic neuroendocrine neoplasms (PanNENs) are a heterogeneous group of tumors. Although the prognosis of resected PanNENs is generally considered to be good, a relatively high recurrence rate has been reported. Given the scarcity of large-scale reports about PanNEN recurrence due to their rarity, we aimed to identify the predictors for recurrence in patients with resected PanNENs to improve prognosis. METHODS: We established a multicenter database of 573 patients with PanNENs, who underwent resection between January 1987 and July 2020 at 22 Japanese centers, mainly in the Kyushu region. We evaluated the clinical characteristics of 371 patients with localized non-functioning pancreatic neuroendocrine tumors (G1/G2). We also constructed a machine learning-based prediction model to analyze the important features to determine recurrence. RESULTS: Fifty-two patients experienced recurrence (14.0&#37;) during the follow-up period, with the median time of recurrence being 33.7 months. The random survival forest (RSF) model showed better predictive performance than the Cox proportional hazards regression model in terms of the Harrell's C-index (0.841 vs. 0.820). The Ki-67 index, residual tumor, WHO grade, tumor size, and lymph node metastasis were the top five predictors in the RSF model; tumor size above 20 mm was the watershed with increased recurrence probability, whereas the 5-year disease-free survival rate decreased linearly as the Ki-67 index increased. CONCLUSIONS: Our study revealed the characteristics of resected PanNENs in real-world clinical practice. Machine learning techniques can be powerful analytical tools that provide new insights into the relationship between the Ki-67 index or tumor size and recurrence.

    DOI: 10.1007/s00535-023-01987-8

  • 症例 ポリープ状の形態を呈した腎細胞癌胆嚢転移の1例

    安部 時子, 藤田 展宏, 牛島 泰宏, 石松 慶祐, 門司 恵介, 古賀 裕, 石神 康生

    臨床放射線   68 ( 5 )   487 - 491   2023.5   ISSN:00099252

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    DOI: 10.18888/rp.0000002332

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  • Effect of iodine concentration and body size on iodine subtraction in virtual non-contrast imaging: A phantom study

    T. Shirasaka, T. Kojima, S. Yamane, R. Mikayama, M. Kawakubo, R. Funatsu, T. Kato, K. Ishigami, Y. Funama

    Radiography   2023.5

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    DOI: 10.1016/j.radi.2023.03.003

  • Extracellular volume fraction determined by dual-layer spectral detector CT: Possible role in predicting the efficacy of preoperative neoadjuvant chemotherapy in pancreatic ductal adenocarcinoma. International journal

    Nobuhiro Fujita, Yasuhiro Ushijima, Masahiro Itoyama, Daisuke Okamoto, Keisuke Ishimatsu, Noriaki Wada, Seiichiro Takao, Ryo Murayama, Nao Fujimori, Kohei Nakata, Masafumi Nakamura, Takeo Yamamoto, Yoshinao Oda, Kousei Ishigami

    European journal of radiology   162   110756 - 110756   2023.5

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    PURPOSE: To clarify the relationship between extracellular volume (ECV) measured by dual-energy CT (DECT) and efficacy of preoperative neoadjuvant chemotherapy (NAC) in patients with pancreatic ductal adenocarcinoma (PDAC), as compared with single-energy CT (SECT). METHODS: We enrolled 67 patients with PDAC who underwent dynamic contrast-enhanced CT with a dual-energy CT system prior to NAC. Attenuation values were measured on unenhanced and the equilibrium-phase 120-kVp equivalent CT images for PDAC and the aorta. ΔHU-tumor, ΔHU-tumor/ΔHU-aorta, and SECT-ECV were calculated. Iodine densities of the tumor and aorta were measured in the equilibrium phase, and DECT-ECV of the tumor was calculated. Response to NAC was evaluated and the correlation between imaging parameters and response to NAC was statistically assessed. RESULTS: Tumor DECT-ECVs were significantly lower in the response group (n = 7) than in the non-response group (n = 60), with most significant difference (p = 0.0104). DECT-ECV showed highest diagnostic value with an Az value of 0.798. When using the optimal cut off value of DECT-ECV (<26.0 &#37;), sensitivity, specificity, accuracy, positive predictive value, and negative value for predicting response group were 71.4 &#37;, 85.0 &#37;, 83.6 &#37;, 35.7 &#37; and 96.2 &#37;, respectively. CONCLUSION: PDAC with lower DECT-ECV can potentially show better response to NAC. DECT-ECV might be a useful biomarker for predicting response to NAC in patients with PDAC.

    DOI: 10.1016/j.ejrad.2023.110756

  • Comparison of radiological and pathological tumor sizes in resected non-small cell lung cancer.

    Taichi Nagano, Shinkichi Takamori, Asato Hashinokuchi, Kyoto Matsydo, Mikihiro Kohno, Naoko Miura, Tomoyoshi Takenaka, Takeshi Kamitani, Mototsugu Shimokawa, Kousei Ishigami, Yoshinao Oda, Tomoharu Yoshizumi

    General thoracic and cardiovascular surgery   2023.5

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    OBJECTIVES: In non-small cell lung cancer (NSCLC), T factor plays an important role in determining staging. The present study aimed to determine the validity of preoperative evaluation of clinical T (cT) factor by comparing radiological and pathological tumor sizes. METHODS: Data for 1,799 patients with primary NSCLC who underwent curative surgery were investigated. The concordance between cT and pathological T (pT) factors was analyzed. Furthermore, we compared groups with an increase or decrease of ≥ 20&#37; and groups with an increase or decrease of < 20&#37; in the size change between preoperative radiological and pathological diameters. RESULTS: The mean sizes of the radiological solid components and the pathological invasive tumors were 1.90 cm and 1.99 cm, respectively, correlation degree = 0.782. The group with increased pathological invasive tumor size (≥ 20&#37;) compared with the radiologic solid component was significantly more likely female, consolidation tumor ratio (CTR) ≤ 0.5, and within cT1. Multivariate logistic analysis identified CTR < 1, cT ≤ T1, and adenocarcinoma as independent risk factors for increased pT factor. CONCLUSION: The radiological invasive area of tumors with cT1, CTR < 1, or adenocarcinoma on preoperative CT may be underestimated compared with pathological invasive diameter.

    DOI: 10.1007/s11748-023-01938-3

  • Amide proton transfer (APT) imaging of breast cancers and its correlation with biological status. International journal

    Takeshi Kamitani, Koji Sagiyama, Yuzo Yamasaki, Takuya Hino, Tatsuhiro Wada, Makoto Kubo, Sayuri Akiyoshi, Hidetaka Yamamoto, Hidetake Yabuuchi, Kousei Ishigami

    Clinical imaging   96   38 - 43   2023.4

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    PURPOSE: To assess the usefulness of amide proton transfer (APT) imaging to predict the biological status of breast cancers. METHOD: Sixty-six patients (age range 31-85 years, mean 58.9 years) with histopathologically proven invasive ductal carcinomas of 2 cm or larger in diameter were included in this study. 3D APT weighted imaging was conducted on a 3 T scanner. Mean APT signal intensity (SI) was analyzed in relation to biological subtypes, Ki-67 labeling index, and nuclear grades (NGs). RESULTS: The triple-negative (TN) cancers (n = 10; 2.75 ± 0.42&#37;) showed significantly higher APT SI than the luminal type cancers (n = 48; 1.74 ± 0.83) and HER2 cancers (n = 8; 1.83 ± 0.21) (P = 0.0007, 0.03). APT SI had weakly positive correlation with the Ki-67 labeling index (r = 0.38, P = 0.002). The mean APT SIs were significantly higher for high-Ki-67 (>30&#37;) (n = 31; 2.25 ± 0.70) than low-Ki-67 (≤30&#37;) cancers (n = 35; 1.60 ± 0.79) (P = 0.0007). There was no significant difference in the APT SIs between NG 1-2 (n = 31; 1.71 ± 0.84) and NG 3 (n = 35; 2.08 ± 0.76&#37;) cancers (P = 0.06). CONCLUSIONS: TN and high-Ki-67 breast cancers showed high APT SIs. APT imaging can help to predict the biological status of breast cancers.

    DOI: 10.1016/j.clinimag.2023.02.002

  • 特集 胸部X線診断再入門 ─症例から学ぶ読影法─ 15 異常影は肺内? それとも肺外? part 2 ─ 胸膜・胸壁疾患

    樋田 知之, 神谷 武志, 藪内 英剛, 石神 康生

    画像診断   43 ( 4 )   S147 - S152   2023.3   ISSN:02850524 eISSN:24321281

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    Publisher:学研メディカル秀潤社  

    DOI: 10.15105/gz.0000004455

    CiNii Research

  • Transcatheter arterial steroid injection therapy improves the prognosis of patients with acute liver failure. International journal

    Akifumi Kuwano, Tasuku Okui, Motoyuki Kohjima, Miho Kurokawa, Takeshi Goya, Masatake Tanaka, Tomomi Aoyagi, Motoi Takahashi, Koji Imoto, Shigeki Tashiro, Hideo Suzuki, Nobuhiro Fujita, Yasuhiro Ushijima, Kousei Ishigami, Shoji Tokunaga, Masaki Kato, Yoshihiro Ogawa

    Medicine   102 ( 10 )   e33090   2023.3

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    Acute liver failure (ALF) is a disorder defined by coagulopathy and encephalopathy with a poor prognosis. No effective therapies have been established except for liver transplantation. We previously reported a subgroup of patients with acute liver injury who developed microcirculatory disturbance. We also established and reported transcatheter arterial steroid injection therapy (TASIT) as a new treatment of ALF. Here, we analyze the effectiveness of TASIT in a larger cohort and evaluate the impact on ALF patients with or without microcirculatory disturbance. We conducted a single-center retrospective study to evaluate the effectiveness of TASIT in patients with ALF admitted at Kyushu University Hospital between January 2005 and March 2018. TASIT is performed by injecting methylprednisolone via the proper hepatic artery for 3 days. One hundred ninety-4 patients with ALF were enrolled and analyzed in this study. Of the 87 patients given TASIT, 71 (81.6&#37;) recovered without any complications and 16 (18.4&#37;) died or underwent liver transplantation. Of the 107 patients not administered TASIT, 77 (72.0&#37;) recovered and 30 (28.0&#37;) progressed to irreversible liver failure. In the high-lactate dehydrogenase subgroup, 52 (86.7&#37;) of the 60 patients with TASIT recovered, and the survival rate was significantly higher than that in patients who did not receive TASIT. Multivariate regression analysis revealed that the TASIT procedure was one of the significant prognostic factors in the high-lactate dehydrogenase subgroup and was significantly associated with prothrombin activity percentage improvement. TASIT is an effective treatment for patients with ALF, especially in those with microcirculatory disturbance.

    DOI: 10.1097/MD.0000000000033090

  • Clinical association between intraoperative indocyanine green fluorescence imaging pattern, preoperative Gd-EOB-DTPA-enhanced magnetic resonance imaging findings, and histological differentiation in hepatocellular carcinoma. International journal

    Takahiro Tomino, Shinji Itoh, Nobuhiro Fujita, Daisuke Okamoto, Yuki Nakayama, Katsuya Toshida, Takahiro Tomiyama, Yuriko Tsutsui, Yukiko Kosai, Takeshi Kurihara, Yoshihiro Nagao, Kazutoyo Morita, Noboru Harada, Yasuhiro Ushijima, Kenichi Kohashi, Kousei Ishigami, Yoshinao Oda, Tomoharu Yoshizumi

    Hepatology research : the official journal of the Japan Society of Hepatology   2023.3

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    AIM: We aimed to evaluate the association between the intraoperative indocyanine green (ICG) fluorescence imaging (FI) pattern, preoperative magnetic resonance imaging (MRI) findings using gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA), preoperative diffusion-weighted imaging (DWI) of MRI, and histological differentiation of hepatocellular carcinoma (HCC). METHODS: We retrospectively reviewed the data for 80 tumors of 64 patients. Intraoperative ICG FI patterns were classified into cancerous or rim-positive type. We evaluated the signal intensity ratio of the tumor and the surrounding liver tissue in the portal phase (SIRPP) and intensity in the hepatobiliary phase (HBP) of Gd-EOB-DTPA-enhanced MRI, the apparent diffusion coefficient (ADC) in the DWI of MRI, and clinicopathologic factors. RESULTS: In the rim-positive group, the rate of poorly differentiated HCC and hypointensity type in HBP were significantly higher, and SIRPP and ADC were significantly lower than the rim-negative group. In the cancerous group, the rate of well or moderately differentiated HCC and hyperintensity type in HBP, SIRPP, and ADC were significantly higher than the noncancerous group. Multivariate analysis identified low SIRPP, low ADC, and hypointensity type in HBP as the significant predictive factors for rim-positive HCC and high SIRPP, high ADC, and hyperintensity type in HBP as the significant predictive factors for cancerous HCC. The positive rate of programmed cell death 1-ligand 1 and vessels that encapsulate tumor clusters status of the rim-positive HCC and HCC with low SIRPP were significantly higher than the control group. CONCLUSIONS: The intraoperative ICG FI pattern of HCC closely correlated with histological differentiation, preoperative SIRPP and intensity type in the Gd-EOB-DTPA MRI, and preoperative ADC in the DWI of MRI.

    DOI: 10.1111/hepr.13902

  • Risks and benefits of pancreaticoduodenectomy in patients aged 80 years and over. International journal

    Naoki Ikenaga, Kohei Nakata, Toshiya Abe, Noboru Ideno, Nao Fujimori, Takamasa Oono, Nobuhiro Fujita, Kousei Ishigami, Masafumi Nakamura

    Langenbeck's archives of surgery   408 ( 1 )   108 - 108   2023.2

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    PURPOSE: The frequency of pancreaticoduodenectomy is increasing in oldest old patients owing to population aging. We aimed to clarify the clinical significance of pancreaticoduodenectomy in patients aged ≥ 80 years with multiple underlying diseases. METHODS: A total of 649 consecutive patients who underwent pancreaticoduodenectomy from April 2010 to March 2021 in our institute were divided into two groups according to their age: ≥ 80 years (51) and ≤ 79 years (598). We compared mortality and morbidity between the groups. The age-related prognosis was analyzed in 302 patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma treatment. RESULTS: There were no significant differences in morbidity (Clavien-Dindo classification grade III or higher; P = 0.1300), mortality (P = 0.0786), or postoperative hospital stay (P = 0.5763) between the groups. Patients aged ≥ 80 years, who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma, had shorter overall survival than those aged ≤ 79 years (median survival time, 16.7 months vs. 32.7 months; P = 0.0206). However, the overall survival of patients aged ≥ 80 years who received perioperative chemotherapy was comparable to that of patients aged ≤ 79 years (P = 0.9795). In the multivariate analysis, the absence of perioperative chemotherapy was identified as an independent prognostic factor, while age ≥ 80 years was not. Perioperative chemotherapy was the sole independent prognostic factor in patients aged ≥ 80 years who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. CONCLUSIONS: Pancreaticoduodenectomy is safe for patients aged ≥ 80 years. The survival benefits of pancreaticoduodenectomy for patients with pancreatic ductal adenocarcinoma aged ≥ 80 years might be limited to those who can receive perioperative chemotherapy.

    DOI: 10.1007/s00423-023-02843-2

  • Skeletal muscle area predicts the outcomes of non-small-cell lung cancer after trimodality therapy. International journal

    Kenji Watanabe, Fumihiko Kinoshita, Tomoyoshi Takenaka, Taichi Nagano, Yuka Oku, Keisuke Kosai, Yuki Ono, Naoki Haratake, Mikihiro Kohno, Takeshi Kamitani, Tadamasa Yoshitake, Tatsuro Okamoto, Mototsugu Shimokawa, Kousei Ishigami, Tomoharu Yoshizumi

    Interdisciplinary cardiovascular and thoracic surgery   36 ( 2 )   2023.2

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    OBJECTIVES: Sarcopenia correlates with poor prognosis in various malignancies. However, the prognostic significance of sarcopenia remains to be determined in patients with non-small-cell lung cancer who undergo surgery after receiving neoadjuvant chemoradiotherapy (NACRT). METHODS: We retrospectively reviewed the patients with stage II/III non-small-cell lung cancer who underwent surgery following NACRT. The paravertebral skeletal muscle area (SMA) (cm2) at the 12th thoracic vertebra level was measured. We calculated the SMA index (SMAI) as SMA/squared height (cm2/m2). Patients were divided into low and high SMAI groups, and the association of SMAI with clinicopathological factors and prognosis was assessed. RESULTS: The patients' [men, 86 (81.1&#37;)] median age was 63 (21-76) years. There were 106 patients including 2 (1.9&#37;), 10 (9.4&#37;), 74 (69.8&#37;), 19 (17.9&#37;) and 1 (0.9&#37;) patients with stage IIA, IIB, IIIA, IIIB and IIIC, respectively. Of the patients, 39 (36.8&#37;) and 67 (63.2&#37;) were classified in the low and the high SMAI groups, respectively. Kaplan-Meier analysis showed that the low group had a significantly shorter overall survival and disease-free survival than the high group. Multivariable analysis identified low SMAI as an independent poor prognostic factor for overall survival. CONCLUSIONS: Pre-NACRT SMAI correlates with poor prognosis; therefore, assessing sarcopenia based on pre-NACRT SMAI may help determine optimal treatment strategies and suitable nutritional and exercise interventions.

    DOI: 10.1093/icvts/ivad020

  • Clinical Implications of FDG-PET in Pancreatic Ductal Adenocarcinoma Patients Treated with Neoadjuvant Therapy. International journal

    Naoki Ikenaga, Kohei Nakata, Masataka Hayashi, So Nakamura, Toshiya Abe, Noboru Ideno, Masatoshi Murakami, Nao Fujimori, Nobuhiro Fujita, Takuro Isoda, Shingo Baba, Kousei Ishigami, Yoshinao Oda, Masafumi Nakamura

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract   27 ( 2 )   337 - 346   2023.2

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    PURPOSE: To evaluate the clinical significance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with pancreatic ductal adenocarcinoma who underwent neoadjuvant therapy. METHODS: Among 285 consecutive patients who underwent pancreatic resection for pancreatic ductal adenocarcinoma between 2015 and 2021, 86 who underwent preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography after completion of neoadjuvant treatment were reviewed. Among preoperative factors, including post-treatment maximum standardized uptake value, predictors of early recurrence and poor prognosis were identified using multivariate analysis for decision making in surgery. RESULTS: Nineteen (22&#37;) patients with pancreatic ductal adenocarcinoma demonstrated high maximum standardized uptake (≥ 4.5). High post-treatment maximum standardized uptake (≥ 4.5) predicted early recurrence within 6 months after surgery and correlated with shorter recurrence-free survival. Elevated post-treatment CA19-9 level (> 37 U/ml) and maximum standardized uptake ≥ 4.5 were independent prognostic factors. Post-treatment, a high maximum standardized uptake value indicated a poorer prognosis than a low maximum standardized uptake value in both patients with elevated CA19-9 and normal CA19-9 levels. The median overall survival in patients with elevated post-treatment CA19-9 and high maximum standardized uptake was only 17 months; 67&#37; experienced early recurrence. Dynamic changes in maximum standardized uptake during neoadjuvant therapy were correlated with pathological response to neoadjuvant therapy, but not with radiological response or change in CA19-9 level. CONCLUSIONS: Post-treatment assessment using maximum standardized uptake value is useful for stratifying patients with pancreatic ductal adenocarcinoma who will benefit from surgery. Instead of subsequent curative resection, additional neoadjuvant therapy should be considered in patients with a persistently high maximum standardized uptake value.

    DOI: 10.1007/s11605-023-05591-2

  • Virtual monochromatic spectral CT imaging in preoperative evaluations for intraductal spread of breast cancer: comparison with conventional CT and MRI.

    Yuko Matsuura, Takeshi Kamitani, Koji Sagiyama, Yuzo Yamasaki, Takuya Hino, Makoto Kubo, Hideki Ijichi, Hidetaka Yamamoto, Hidetake Yabuuchi, Kousei Ishigami

    Japanese journal of radiology   2023.2

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    PURPOSE: To investigate the efficacy of virtual monochromatic spectral computed tomography imaging (VMI) in the preoperative evaluation for intraductal spread of breast cancer. MATERIALS AND METHODS: Twenty-four women who underwent spectral CT and were pathologically diagnosed with ductal carcinoma with a ≥ 2-cm noninvasive component were retrospectively enrolled in Group 1. Twenty-two women with 22 lesions pathologically diagnosed with ductal carcinoma in situ or microinvasive carcinoma were enrolled in Group 2. We compared the contrast-to-noise ratios (CNRs) of the lesions on conventional 120-kVp CT images and 40-keV VMIs in Group 1. Two board-certified radiologists measured the maximum diameters of enhancing areas on 120-kVp CT, 40-keV VMI, and MRI in Group 2 and compared with histopathological sizes. RESULTS: The quantitative assessment of Group 1 revealed that the mean ± SD of the CNRs in the 40-keV images were significantly greater than those in the 120-kVp images (5.5 ± 1.9 vs. 3.6 ± 1.5, p < 0.0001). The quantitative assessment of Group 2 demonstrated that the lesion size observed in the conventional 120-kVp CT images by both readers was significantly underestimated as compared to the histopathological size (p = 0.017, 0.048), whereas both readers identified no significant differences between the lesion size measured on 40-keV VMI and the histopathological data. In a comparison with MRI, 40-keV VMI provided measurement within a 10-mm error range in more lesions as compared to the conventional 120-kVp CT. CONCLUSION: VMI improves the evaluation of intraductal spread and is useful for the preoperative evaluations of breast cancer.

    DOI: 10.1007/s11604-023-01392-4

  • A Prospective Multicenter Phase II Trial of Neoadjuvant Chemotherapy with Gemcitabine Plus Nab-Paclitaxel for Borderline Resectable Pancreatic Cancer with Arterial Involvement. International journal

    Naoki Ikenaga, Yoshihiro Miyasaka, Takao Ohtsuka, Kohei Nakata, Tomohiko Adachi, Susumu Eguchi, Kazuyoshi Nishihara, Masafumi Inomata, Hiroshi Kurahara, Toru Hisaka, Hideo Baba, Hiroaki Nagano, Toshiharu Ueki, Hirokazu Noshiro, Shoji Tokunaga, Kousei Ishigami, Masafumi Nakamura

    Annals of surgical oncology   30 ( 1 )   193 - 202   2023.1

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    BACKGROUND: Only two clinical trials have shown the effects of neoadjuvant treatment for borderline resectable pancreatic cancer with arterial involvement (BRPC-A). Here, we aimed to analyze the efficacy and safety of neoadjuvant gemcitabine plus nab-paclitaxel (GnP) for BRPC-A. PATIENTS AND METHODS: A prospective, single-arm, multicenter phase II trial was conducted. Patients who were radiologically and histologically diagnosed with BRPC-A were enrolled. A central review was conducted to confirm the presence of BRPC-A. Patients received two to four cycles of GnP before surgery. The primary endpoint of the study was the R0 resection rate. Overall survival (OS) was evaluated in an ancillary study. RESULTS: Thirty-five patients were enrolled, of whom 33 were subjected to central review and 28 were confirmed to have BRPC-A. All eligible patients with BRPC-A received neoadjuvant GnP. Nineteen patients underwent pancreatic resections. Postoperative complications of Clavien-Dindo IIIa or lower were observed in 11 patients. No treatment-related mortalities were observed. R0 resection was achieved in 17 patients (89&#37;); the R0 resection rate was 61&#37; in eligible patients. One patient underwent curative resection after termination of the treatment protocol, resulting in an overall R0 resection rate of 64&#37;. The median overall survival (OS) and 2-year OS rate were 24.9 months [95&#37; confidence interval (CI) 19.0 months to not estimatable] and 53.6&#37;, respectively. OS in patients with BRPC-A who achieved overall R0 resection was significantly longer than that in the other patients (p = 0.0255). CONCLUSIONS: Neoadjuvant GnP is a safe and effective strategy for BRPC-A, providing a chance for curative resection and improved survival.

    DOI: 10.1245/s10434-022-12566-1

  • Impact of a new deep-learning-based reconstruction algorithm on image quality in ultra-high-resolution CT: clinical observational and phantom studies. International journal

    Yuki Sakai, Tomoyuki Hida, Yuko Matsuura, Takeshi Kamitani, Yasuhiro Onizuka, Takashi Shirasaka, Toyoyuki Kato, Kousei Ishigami

    The British journal of radiology   96 ( 1141 )   20220731 - 20220731   2023.1

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    OBJECTIVES: To demonstrate the effect of an improved deep learning-based reconstruction (DLR) algorithm on Ultra-High-Resolution Computed Tomography (U-HRCT) scanners. METHODS: Clinical and phantom studies were conducted. Thirty patients who underwent contrast-enhanced CT examination during the follow-up period were enrolled. Images were reconstructed using improved DLR [termed, New DLR, i.e., Advanced Intelligent Clear-IQ Engine (AiCE) Body Sharp] and conventional DLR (Conv DLR, AiCE Body) algorithms. Two radiologists assessed the overall image quality using a 5-point scale (5 = excellent; 1 = unacceptable). The noise power spectra (NPSs) were calculated to assess the frequency characteristics of the image noise, and the square root of area under the curve (√AUC NPS) between 0.05 and 0.50 cycle/mm was calculated as an indicator of the image noise. Dunnett's test was used for statistical analysis of the visual evaluation score, with statistical significance set at p < 0.05. RESULTS: The overall image quality of New DLR was better than that of the Conv DLR (4.2 ± 0.4 and 3.3 ± 0.4, respectively; p < 0.0001). All New DLR images had an overall image quality score above the average or excellent. The √AUCNPS value of New DLR was lower than that of Conv DLR (13.8 and 14.2, respectively). The median values of reconstruction time required with New DLR and Conv DLR were 5.0 and 7.8 min, respectively. CONCLUSIONS: The new DLR algorithm improved the image quality within a practical reconstruction time. ADVANCES IN KNOWLEDGE: The new DLR enables us to choose whether to improve image quality or reduce the dose.

    DOI: 10.1259/bjr.20220731

  • Severe COVID-19 pneumonia leads to post-COVID-19 lung abnormalities on follow-up CT scans*

    Hino, T; Nishino, M; Valtchinov, VI; Gagne, S; Gay, E; Wada, N; Tseng, SC; Madore, B; Guttmann, CRG; Ishigami, K; Li, Y; Christiani, DC; Hunninghake, GM; Levy, BD; Kaye, KM; Hatabu, H

    EUROPEAN JOURNAL OF RADIOLOGY OPEN   10   100483   2023   ISSN:2352-0477 eISSN:2352-0477

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    Language:English   Publisher:European Journal of Radiology Open  

    Purpose: To investigate the association of the maximal severity of pneumonia on CT scans obtained within 6-week of diagnosis with the subsequent development of post-COVID-19 lung abnormalities (Co-LA). Methods: COVID-19 patients diagnosed at our hospital between March 2020 and September 2021 were studied retrospectively. The patients were included if they had (1) at least one chest CT scan available within 6-week of diagnosis; and (2) at least one follow-up chest CT scan available ≥ 6 months after diagnosis, which were evaluated by two independent radiologists. Pneumonia Severity Categories were assigned on CT at diagnosis according to the CT patterns of pneumonia and extent as: 1) no pneumonia (Estimated Extent, 0%); 2) non-extensive pneumonia (GGO and OP, <40%); and 3) extensive pneumonia (extensive OP and DAD, >40%). Co-LA on follow-up CT scans, categorized using a 3-point Co-LA Score (0, No Co-LA; 1, Indeterminate Co-LA; and 2, Co-LA). Results: Out of 132 patients, 42 patients (32%) developed Co-LA on their follow-up CT scans 6–24 months post diagnosis. The severity of COVID-19 pneumonia was associated with Co-LA: In 47 patients with extensive pneumonia, 33 patients (70%) developed Co-LA, of whom 18 (55%) developed fibrotic Co-LA. In 52 with non-extensive pneumonia, 9 (17%) developed Co-LA: In 33 with no pneumonia, none (0%) developed Co-LA. Conclusions: Higher severity of pneumonia at diagnosis was associated with the increased risk of development of Co-LA after 6–24 months of SARS-CoV-2 infection.

    DOI: 10.1016/j.ejro.2023.100483

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    PubMed

  • Quantitative relaxometry using synthetic MRI could be better than T2-FLAIR mismatch sign for differentiation of IDH-mutant gliomas: a pilot study

    Kazufumi Kikuchi, Osamu Togao, Koji Yamashita, Daichi Momosaka, Yoshitomo Kikuchi, Daisuke Kuga, Nobuhiro Hata, Masahiro Mizoguchi, Hidetaka Yamamoto, Toru Iwaki, Akio Hiwatashi, Kousei Ishigami

    Scientific Reports   12 ( 1 )   2022.12

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    This study aimed to determine whether quantitative relaxometry using synthetic magnetic resonance imaging (SyMRI) could differentiate between two diffuse glioma groups with isocitrate dehydrogenase (IDH)-mutant tumors, achieving an increased sensitivity compared to the qualitative T2-fluid-attenuated inversion recovery (FLAIR) mismatch sign. Between May 2019 and May 2020, thirteen patients with IDH-mutant diffuse gliomas, including seven with astrocytomas and six with oligodendrogliomas, were evaluated. Five neuroradiologists independently evaluated the presence of the qualitative T2-FLAIR mismatch sign. Interrater agreement on the presence of the T2-FLAIR mismatch sign was calculated using the Fleiss kappa coefficient. SyMRI parameters (T1 and T2 relaxation times and proton density) were measured in the gliomas and compared by the Mann–Whitney U test. Receiver operating characteristic curve analysis was used to evaluate the diagnostic performance. The sensitivity, specificity, and kappa coefficient were 57.1&#37;, 100&#37;, and 0.60, respectively, for the qualitative T2-FLAIR mismatch sign. The two types of diffuse gliomas could be differentiated using a cutoff value of 178 ms for the T2 relaxation time parameter with 100&#37; sensitivity, specificity, accuracy, and positive and negative predictive values, with an area under the curve (AUC) of 1.00. Quantitative relaxometry using SyMRI could differentiate astrocytomas from oligodendrogliomas, achieving an increased sensitivity and objectivity compared to the qualitative T2-FLAIR mismatch sign.

    DOI: 10.1038/s41598-022-13036-0

  • A deep learning model based on fusion images of chest radiography and X-ray sponge images supports human visual characteristics of retained surgical items detection. International journal

    Masateru Kawakubo, Hiroto Waki, Takashi Shirasaka, Tsukasa Kojima, Ryoji Mikayama, Hiroshi Hamasaki, Hiroshi Akamine, Toyoyuki Kato, Shingo Baba, Shin Ushiro, Kousei Ishigami

    International journal of computer assisted radiology and surgery   18 ( 8 )   1459 - 1467   2022.12

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    PURPOSE: Although a novel deep learning software was proposed using post-processed images obtained by the fusion between X-ray images of normal post-operative radiography and surgical sponge, the association of the retained surgical item detectability with human visual evaluation has not been sufficiently examined. In this study, we investigated the association of retained surgical item detectability between deep learning and human subjective evaluation. METHODS: A deep learning model was constructed from 2987 training images and 1298 validation images, which were obtained from post-processing of the image fusion between X-ray images of normal post-operative radiography and surgical sponge. Then, another 800 images were used, i.e., 400 with and 400 without surgical sponge. The detection characteristics of retained sponges between the model and a general observer with 10-year clinical experience were analyzed using the receiver operator characteristics. RESULTS: The following values from the deep learning model and observer were, respectively, derived: Cutoff values of probability were 0.37 and 0.45; areas under the curves were 0.87 and 0.76; sensitivity values were 85&#37; and 61&#37;; and specificity values were 73&#37; and 92&#37;. CONCLUSION: For the detection of surgical sponges, we concluded that the deep learning model has higher sensitivity, while the human observer has higher specificity. These characteristics indicate that the deep learning system that is complementary to humans could support the clinical workflow in operation rooms for prevention of retained surgical items.

    DOI: 10.1007/s11548-022-02816-8

  • Grading of gliomas using 3D CEST imaging with compressed sensing and sensitivity encoding. International journal

    Tatsuhiro Wada, Osamu Togao, Chiaki Tokunaga, Masahiro Oga, Kazufumi Kikuchi, Koji Yamashita, Hidetaka Yamamoto, Masami Yoneyama, Koji Kobayashi, Toyoyuki Kato, Kousei Ishigami, Hidetake Yabuuchi

    European journal of radiology   158   110654 - 110654   2022.12

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    PURPOSE: We evaluated the usefulness of three-dimensional (3D) chemical exchange saturation transfer (CEST) imaging with compressed sensing and sensitivity encoding (CS-SENSE) for differentiating low-grade gliomas (LGGs) from high-grade gliomas (HGGs). METHODS: We evaluated 28 patients (mean age 51.0 ± 13.9 years, 13 males, 15 females) including 12 with LGGs and 16 with HGGs, all acquired using a 3 T magnetic resonance (MR) scanner. Nine slices were acquired for 3D CEST imaging, and one slice was acquired for two-dimensional (2D) CEST imaging. Two radiological technologists each drew a region of interest (ROI) surrounding the high-signal-intensity area(s) on the fluid-attenuated inversion recovery image of each patient. We compared the magnetization transfer ratio asymmetry (MTRasym) at 3.5 ppm in the tumors among the (i) single-slice 2D CEST imaging ("2D"), (ii) all tumor slices of the 3D CEST imaging (3Dall), and (iii) a representative tumor slice of 3D CEST imaging (maximum signal intensity [3Dmax]). The relationship between the MTRasym at 3.5 ppm values measured by these three methods and the Ki-67 labeling index (LI) of the tumors was assessed. Diagnostic performance was evaluated with a receiver operating characteristic analysis. The Ki-67LI and MTRasym at 3.5 ppm values were compared between the LGGs and HGGs. RESULTS: A moderate positive correlation between the MTRasym at 3.5 ppm and the Ki-67LI was observed with all three methods. All methods proved a significantly larger MTRasym at 3.5 ppm for the HGGs compared to the LGGs. All methods showed equivalent diagnostic performance. The signal intensity varied depending on the slice position in each case. CONCLUSIONS: The 3D CEST imaging provided the MTRasym at 3.5 ppm for each slice cross-section; its diagnostic performance was also equivalent to that of 2D CEST imaging.

    DOI: 10.1016/j.ejrad.2022.110654

  • 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). International journal

    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   157   110546 - 110546   2022.12

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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 &#37; forced expiratory volume in one second (&#37;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 &#37;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 &#37;FEV1.

    DOI: 10.1016/j.ejrad.2022.110546

  • 症例 食道癌の化学放射線療法後の縦隔リンパ節再発に対し重粒子線治療が奏効した1例

    吉満 凜吾, 吉武 忠正, 浅井 佳央里, 松本 圭司, 髙木 正統, 篠藤 誠, 塩山 善之, 石神 康生

    臨床放射線   67 ( 12 )   1685 - 1690   2022.11   ISSN:00099252

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    Publisher:金原出版  

    DOI: 10.18888/rp.0000002176

    CiNii Research

  • Assessment of cerebral perfusion in moyamoya disease with dynamic pseudo-continuous arterial spin labeling using a variable repetition time scheme with optimized background suppression. International journal

    Osamu Togao, Makoto Obara, Koji Yamashita, Kazufumi Kikuchi, Koichi Arimura, Ataru Nishimura, Akira Nakamizo, Tatsuhiro Wada, Chiaki Tokunaga, Ryoji Mikayama, Yasuo Yamashita, Hiroshi Hamano, Marc Van Cauteren, Kousei Ishigami, Shingo Baba

    Neuroradiology   2022.11

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    PURPOSE: Accurate assessment of cerebral perfusion in moyamoya disease is necessary to determine the indication for treatment. We aimed to investigate the usefulness of dynamic PCASL using a variable TR scheme with optimized background suppression in the evaluation of cerebral perfusion in moyamoya disease. METHODS: We retrospectively analyzed the images of 24 patients (6 men and 18 women, mean age 31.4 ± 18.2 years) with moyamoya disease; each of whom was imaged with both dynamic PCASL using the variable-TR scheme and 123IMP SPECT with acetazolamide challenge. ASL dynamic data at 10 phases are acquired by changing the LD and PLD. The background suppression timing was optimized for each phase. CBF and ATT were measured with ASL, and CBF and CVR to an acetazolamide challenge were measured with SPECT. RESULTS: A significant moderate correlation was found between the CBF measured by dynamic PCASL and that by SPECT (r = 0.53, P < 0.001). The CBF measured by dynamic PCASL (52.5 ± 13.3 ml/100 mg/min) was significantly higher than that measured by SPECT (43.0 ± 12.6 ml/100 mg/min, P < 0.001). The ATT measured by dynamic PCASL showed a significant correlation with the CVR measured by SPECT (r = 0.44, P < 0.001). ATT was significantly longer in areas where the CVR was impaired (CVR < 18.4&#37;, ATT = 1812 ± 353 ms) than in areas where it was preserved (CVR > 18.4&#37;, ATT = 1301 ± 437 ms, P < 0.001). The ROC analysis showed a moderate accuracy (AUC = 0.807, sensitivity = 87.7&#37;, specificity = 70.4&#37;) when the cutoff value of ATT was set at 1518 ms. CONCLUSION: Dynamic PCASL using this scheme was found to be useful for assessing cerebral perfusion in moyamoya disease.

    DOI: 10.1007/s00234-022-03095-5

  • Efficacy of Dynamic Chest Radiography for Chronic Thromboembolic Pulmonary Hypertension. International journal

    Yuzo Yamasaki, Kohtaro Abe, Takeshi Kamitani, Kazuya Hosokawa, Tomoyuki Hida, Koji Sagiyama, Yuko Matsuura, Shingo Baba, Takuro Isoda, Yasuhiro Maruoka, Yoshiyuki Kitamura, Shohei Moriyama, Hideki Yoshikawa, Takenori Fukumoto, Hidetake Yabuuchi, Kousei Ishigami

    Radiology   220908 - 220908   2022.11

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    Background While current guidelines require lung ventilation-perfusion (V/Q) scanning as the first step to diagnose chronic pulmonary embolism in pulmonary hypertension (PH), its use may be limited by low availability and/or exposure to ionizing radiation. Purpose To compare the performance of dynamic chest radiography (DCR) and lung V/Q scanning for detection of chronic thromboembolic PH (CTEPH). Materials and Methods Patients with PH who underwent DCR and V/Q scanning in the supine position from December 2019 to July 2021 were retrospectively screened. The diagnosis of CTEPH was confirmed with right heart catheterization and invasive pulmonary angiography. Observer tests were conducted to evaluate the diagnostic accuracy of DCR and V/Q scanning. The lungs were divided into six areas (upper, middle, and lower for both) in the anteroposterior image, and the number of lung areas with thromboembolic perfusion defects was scored. Diagnostic performance was compared between DCR and V/Q scanning using the area under the receiver operating characteristic curve. Agreement between the interpretation of DCR and that of V/Q scanning was assessed using the Cohen kappa coefficient and percent agreement. Results A total of 50 patients with PH were analyzed: 29 with CTEPH (mean age, 64 years ± 15 [SD]; 19 women) and 21 without CTEPH (mean age, 61 years ± 22; 14 women). The sensitivity, specificity, and accuracy of DCR were 97&#37;, 86&#37;, and 92&#37;, respectively, and those of V/Q scanning were 100&#37;, 86&#37;, and 94&#37;, respectively. Areas under the receiver operating characteristic curve for DCR and V/Q scanning were 0.92 (95&#37; CI: 0.79, 0.97) and 0.93 (95&#37; CI: 0.78, 0.98). Agreement between the consensus interpretation of DCR and that of V/Q scanning was substantial (κ = 0.79 [95&#37; CI: 0.61, 0.96], percent agreement = 0.9 [95&#37; CI: 0.79, 0.95]). Conclusion Dynamic chest radiography had similar efficacy to ventilation-perfusion scanning in the detection of chronic thromboembolic pulmonary hypertension. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Wandtke and Koproth-Joslin in this issue.

    DOI: 10.1148/radiol.220908

  • 食道癌の化学放射線療法後の縦隔リンパ節再発に対し重粒子線治療が奏効した1例

    吉満 凜吾, 吉武 忠正, 浅井 佳央里, 松本 圭司, 高木 正統, 篠藤 誠, 塩山 善之, 石神 康生

    臨床放射線   67 ( 12 )   1685 - 1690   2022.11   ISSN:0009-9252

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    70歳代男性。胸部中部食道癌に対する化学放射線療法から7ヵ月後、縦隔リンパ節再発が認められた。FP療法を1コース施行するも効果なく、重粒子線治療を施行したところ、奏効した。最終治療から5年以上経過現在、再発や重篤な有害事象はみられない。

  • Clinical significance of postpancreatectomy acute pancreatitis defined by the International Study Group for Pancreatic Surgery

    Ikenaga, N; Nakata, K; Fujita, N; Abe, T; Ideno, N; Ishigami, K; Nakamura, M

    ANNALS OF GASTROENTEROLOGICAL SURGERY   6 ( 6 )   842 - 850   2022.11   ISSN:2475-0328

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    Aim: The International Study Group for Pancreatic Surgery (ISGPS) developed a structured definition of postpancreatectomy acute pancreatitis (PPAP) in 2021. This study aimed to evaluate the clinical significance of PPAP as defined by the ISGPS criteria. Methods: We evaluated the medical records and postoperative computed tomography (CT) findings of 247 patients who underwent pancreaticoduodenectomy. Postoperative hyperamylasemia (POH) was defined as an elevation in serum amylase levels over the upper baseline limit (≥133 U/L) on postoperative days 1 and 3. PPAP was defined as acute pancreatitis satisfying the following three requirements: POH, clinically relevant deterioration, and radiologic features consistent with acute pancreatitis. Results: Postoperative hyperamylasemia and PPAP were prevalent in 9.7% (24/247) and 3.6% (9/247) of the patients, respectively. PPAP grade B occurred in eight patients, seven of whom experienced Clavien–Dindo grade IIIA complications, including postoperative pancreatic fistula (POPF) and extended periods of postoperative hospitalization. PPAP grade C occurred in one patient, who died from the exacerbation of underlying interstitial pneumonia following the POPF occurrence. Acute pancreatitis determined by CT was observed in 15.3% (38/247) of the patients who underwent pancreaticoduodenectomy and was strongly associated with severe morbidity (P <.0001) and longer postoperative hospitalization (P <.0001). POH preceded acute pancreatitis on CT in only 23.7% (9/38) of those cases, resulting in a low incidence rate of PPAP. Conclusion: Post-pancreatectomy acute pancreatitis is a major postoperative complication of pancreatic resection; however, based on the current ISGPS criteria, its prevalence is low. Defining PPAP promotes universal evaluation and understanding of this new concept.

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  • 特集 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5章 消化器 6 消化管腫瘍

    西牟田 雄祐, 鶴丸 大介, 甲斐 聖広, 石神 康生

    臨床放射線   67 ( 11 )   1389 - 1397   2022.10   ISSN:00099252

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    DOI: 10.18888/rp.0000002137

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  • 特集 専攻医1年目で知っておきたいCT 14のこと~指導医からのメッセージ~ 指導医が伝えるCT読影のコツ 消化管出血

    鶴丸 大介, 西牟田 雄祐, 甲斐 聖広, 石神 康生

    臨床画像   38 ( 14 )   144 - 150   2022.10   ISSN:09111069

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    DOI: 10.18885/ci.0000001064

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  • High-resolution systolic T1 mapping with compressed sensing for the evaluation of the right ventricle: a phantom and volunteer study. International journal

    Daisuke Nishigake, Yuzo Yamasaki, Kenichiro Yamamura, Ryohei Funatsu, Tatsuhiro Wada, Masahiro Oga, Koji Kobayashi, Toyoyuki Kato, Kousei Ishigami

    The international journal of cardiovascular imaging   38 ( 10 )   2219 - 2225   2022.10

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    To investigate the usefulness of high-resolution systolic T1 mapping using compressed sensing for right ventricular (RV) evaluation. Phantoms and normal volunteers were scanned at 3 T by using a high-resolution (HR) modified look-locker inversion recovery (MOLLI) pulse sequence and a conventional MOLLI pulse sequence. The T1 values of the left ventricular (LV) and RV myocardium and blood pool were measured for each sequence. T1 values of HR-MOLLI and MOLLI sequences were compared in the LV myocardium, blood pool, and RV myocardium. The T1 values of HR-MOLLI and MOLLI showed good agreement in both phantoms and the LV myocardium and blood pool of volunteers. However, there was a significant difference between HR-MOLLI and MOLLI in the RV myocardium (1258 ± 52 ms vs. 1327 ± 73 ms; P = 0.0005). No significant difference was observed between the T1 value of RV and that of LV (1217 ± 32 ms) in HR-MOLLI, whereas the T1 value of RV was significantly higher than that of LV in MOLLI (P < 0.0001). The interclass correlation coefficients of intraobserver variabilities from HR-MOLLI and MOLLI were 0.919 and 0.804, respectively, and the interobserver variabilities from HR-MOLLI and MOLLI were 0.838 and 0.848, respectively. Assessment of RV myocardium by using HR systolic T1 mapping was superior to the conventional MOLLI sequence in terms of accuracy and reproducibility.

    DOI: 10.1007/s10554-022-02622-y

  • A novel fast kilovoltage switching dual-energy computed tomography technique with deep learning: Utility for non-invasive assessments of liver fibrosis. International journal

    Noriaki Wada, Nobuhiro Fujita, Keisuke Ishimatsu, Seiichiro Takao, Tomoharu Yoshizumi, Yoshiko Miyazaki, Yoshinao Oda, Akihiro Nishie, Kousei Ishigami, Yasuhiro Ushijima

    European journal of radiology   155   110461 - 110461   2022.10

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    PURPOSE: To investigate whether the iodine density of liver parenchyma in the equilibrium phase and extracellular volume fraction (ECV) measured by deep learning-based spectral computed tomography (CT) can enable noninvasive liver fibrosis staging. METHOD: We retrospectively analyzed 63 patients who underwent dynamic CT using deep learning-based spectral CT before a hepatectomy or liver transplantation. The iodine densities of the liver parenchyma (I-liver) and abdominal aorta (I-aorta) were independently measured by two radiologists using iodine density images at the equilibrium phase. The iodine-density ratio (I-ratio: I-liver/I-aorta) and CT-ECV were calculated. Spearman's rank correlation analysis was used to evaluate the relationship between the I-ratio or CT-ECV and liver fibrosis stage, and receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performances of the I-ratio and CT-ECV. RESULTS: The I-ratio and CT-ECV showed significant positive correlations with liver fibrosis stage (ρ = 0.648, p < 0.0001 and ρ = 0.723, p < 0.0001, respectively). The areas under the ROC curve for the CT-ECV were 0.882 (F0 vs ≥ F1), 0.873 (≤F1 vs ≥ F2), 0.848 (≤F2 vs ≥ F3), and 0.891 (≤F3 vs F4). CONCLUSIONS: Deep learning-based spectral CT may be useful for noninvasive assessments of liver fibrosis.

    DOI: 10.1016/j.ejrad.2022.110461

  • Three-dimensional chemical exchange saturation transfer imaging using compressed SENSE for full z-spectrum acquisition

    Tatsuhiro Wada, Chiaki Tokunaga, Osamu Togao, Akio Hiwatashi, Kazufumi Kikuchi, Masami Yoneyama, Koji Kobayashi, Toyoyuki Kato, Koji Yoshimoto, Kousei Ishigami, Hidetake Yabuuchi

    Magnetic Resonance Imaging   92   58 - 66   2022.10

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    DOI: 10.1016/j.mri.2022.05.014

  • Prognostic value of pre-transplantation total metabolic tumor volume on <SUP>18</SUP>fluoro-2-deoxy-d-glucose positron emission tomography-computed tomography in relapsed and refractory aggressive lymphoma

    Sugio, T; Baba, S; Mori, Y; Yoshimoto, G; Kamesaki, K; Takashima, S; Urata, S; Shima, T; Miyawaki, K; Kikushige, Y; Kunisaki, Y; Numata, A; Takenaka, K; Iawasaki, H; Miyamoto, T; Ishigami, K; Akashi, K; Kato, K

    INTERNATIONAL JOURNAL OF HEMATOLOGY   116 ( 4 )   603 - 611   2022.10   ISSN:0925-5710 eISSN:1865-3774

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    Relapsed and refractory aggressive lymphoma have a poor prognosis. High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (auto-HSCT) is effective in chemosensitive patients. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is among the few options for non-chemosensitive patients. 18Fluoro-2-deoxy-d-glucose positron emission tomography–computed tomography (18FDG-PET/CT) is the standard tool for evaluating response to chemotherapy and residual tumor volume. However, accurate assessment of residual tumor volume is not currently being achieved in clinical practice, and its value in prognostic and therapeutic stratification remains unclear. To answer this question, we investigated the efficacy of quantitative indicators, including total metabolic tumor volume (TMTV), in predicting prognosis after auto-HSCT and allo-HSCT. We retrospectively analyzed 39 patients who received auto-HSCT and 28 who received allo-HSCT. In the auto-HSCT group, patients with a higher TMTV had a poor prognosis due to greater risk of relapse. In the allo-HSCT group, patients with a higher TMTV had a lower progression-free survival rate and a significantly higher relapse rate. Neither Deauville score nor other clinical parameters were associated with prognosis in either group. Therefore, pre-transplant TMTV on PET is effective for prognostic prediction and therapeutic decision-making for relapsed or refractory aggressive lymphoma.

    DOI: 10.1007/s12185-022-03394-w

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  • Clinical significance of the combination of preoperative SUVmax and CEA in patients with clinical stage IA lung adenocarcinoma. International journal

    Asato Hashinokuchi, Naoki Haratake, Tomoyoshi Takenaka, Kyoto Matsudo, Taichi Nagano, Kenji Watanabe, Keisuke Kosai, Yuka Oku, Yuki Ono, Shinkichi Takamori, Mikihiro Kohno, Shingo Baba, Kousei Ishigami, Tomoharu Yoshizumi

    Thoracic cancer   13 ( 18 )   2624 - 2632   2022.9

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    BACKGROUND: Preoperative maximum standardized uptake value (SUVmax) of 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography and serum carcinoembryonic antigen (CEA) have been reported as prognostic factors for lung adenocarcinoma. However, the significance of combined SUVmax and CEA in early-stage lung adenocarcinoma is not well known. METHODS: We retrospectively evaluated the relationship between the combination of SUVmax and CEA and the prognosis of 410 patients with clinical stage IA lung adenocarcinoma who underwent resection. The cutoff values for SUVmax and CEA were determined by receiver operating characteristic curve analysis, and patients were categorized into high SC (SUVmax and CEA) group (SUVmax ≥2.96 and CEA ≥5.3), moderate SC group (either SUVmax <2.96 and CEA ≥5.3 or SUVmax ≥2.96 and CEA <5.3) and low SC group (SUVmax <2.96 and CEA <5.3). RESULTS: Kaplan-Meier curve analysis showed that patients with clinical stage IA lung adenocarcinoma in the high SC group had significantly shorter overall survival (OS) and recurrence-free survival (RFS) than the other groups (p = 0.011 and p < 0.0001, respectively). Multivariate analysis showed that high SC was an independent prognostic factor of OS (p = 0.029) and RFS (p < 0.0001). CONCLUSIONS: High values of SUVmax and CEA were associated with poor OS and RFS in patients with stage IA lung adenocarcinoma. Simultaneous evaluation of SUVmax and CEA may be an effective prognostic marker to determine the optimal treatment strategy of early-stage lung adenocarcinoma.

    DOI: 10.1111/1759-7714.14599

  • ASO Visual Abstract: A Prospective, Multicenter, Phase II, Trial of Neoadjuvant Chemotherapy with Gemcitabine Plus Nab-Paclitaxel for Borderline Resectable Pancreatic Cancer with Arterial Involvement. International journal

    Naoki Ikenaga, Yoshihiro Miyasaka, Takao Ohtsuka, Kohei Nakata, Tomohiko Adachi, Susumu Eguchi, Kazuyoshi Nishihara, Masafumi Inomata, Hiroshi Kurahara, Toru Hisaka, Hideo Baba, Hiroaki Nagano, Toshiharu Ueki, Hirokazu Noshiro, Shoji Tokunaga, Kousei Ishigami, Masafumi Nakamura

    Annals of surgical oncology   2022.9

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    DOI: 10.1245/s10434-022-12611-z

  • 食道疾患の診療 Ⅲ 食道癌の診療 20 食道癌に対する集学的治療-化学放射線療法

    髙木 正統, 吉武 忠正, 石神 康生

    臨床消化器内科   37 ( 9 )   1154 - 1157   2022.8   ISSN:0911601X eISSN:24332488

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    Publisher:日本メディカルセンター  

    DOI: 10.19020/cg.0000002324

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  • Dynamic Chest Radiography of Acute Pulmonary Thromboembolism. International journal

    Yuzo Yamasaki, Kazuya Hosokawa, Kohtaro Abe, Kousei Ishigami

    Radiology. Cardiothoracic imaging   4 ( 4 )   e220086   2022.8

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    Supplemental material is available for this article.

    DOI: 10.1148/ryct.220086

  • MR Prediction of Malignant Switch With the Cyst Fluid?s T2 Value in Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Preliminary Study

    Takao, S; Nishie, A; Ushijima, Y; Takayama, Y; Morita, K; Ishimatsu, K; Koga, Y; Mori, Y; Akamine, Y; Ishigami, K

    ANTICANCER RESEARCH   42 ( 8 )   3895 - 3903   2022.8   ISSN:0250-7005 eISSN:1791-7530

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    Background/Aim: We investigated whether the malignant switch of intraductal papillary mucinous neoplasm (IPMN) of the pancreas can be predicted by using the T1ρ, T2, and apparent diffusion coefficient (ADC) values of cyst fluid. Patients and Methods: We retrospectively analyzed the magnetic resonance (MR) images of 60 patients (26 males, 34 females, mean age 61 years) with branch-duct type and mixed-type IPMNs. The IPMNs were diagnosed clinically in 39 patients and histologically in 21 patients. The malignant potential was classified by MR imaging based on the international consensus guidelines for the management of IPMN established in 2017. Morphologically, 42 patients had "worrisome features" and three had "high-risk stigmata." Histologically, 14 lesions were diagnosed as low-grade dysplasia and seven as intermediate-grade dysplasia. The T1ρ, T2, and ADC values of cyst fluid in each patient's largest cyst were measured on the same slice, avoiding solid components. Spearman's rank correlation test was used to determine the correlation between the morphological malignancy and the T1ρ, T2, and ADC values. These values were also compared between the low-grade and intermediate-grade groups by Mann-Whitney U-test. Results: There was a significant rank-correlation between the morphological classification and T2 value (p=0.04). The T2 value of the intermediate-grade group was significantly higher than that of the low-grade group (p=0.03). No significant correlations were morphologically or histologically obtained regarding T1ρ and ADC. Conclusion: The T2 value of cyst fluid together with other MR-signs may be useful for predicting the malignant switch in IPMN of the pancreas.

    DOI: 10.21873/anticanres.15883

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  • A deep learning-based approach for the diagnosis of adrenal adenoma: a new trial using CT. International journal

    Masaoki Kusunoki, Tomohiro Nakayama, Akihiro Nishie, Yasuo Yamashita, Kazufumi Kikuchi, Masatoshi Eto, Yoshinao Oda, Kousei Ishigami

    The British journal of radiology   95 ( 1135 )   20211066 - 20211066   2022.7

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    OBJECTIVE: To develop and validate deep convolutional neural network (DCNN) models for the diagnosis of adrenal adenoma (AA) using CT. METHODS: This retrospective study enrolled 112 patients who underwent abdominal CT (non-contrast, early, and delayed phases) with 107 adrenal lesions (83 AAs and 24 non-AAs) confirmed pathologically and with 8 lesions confirmed by follow-up as metastatic carcinomas. Three patients had adrenal lesions on both sides. We constructed six DCNN models from six types of input images for comparison: non-contrast images only (Model A), delayed phase images only (Model B), three phasic images merged into a 3-channel (Model C), relative washout rate (RWR) image maps only (Model D), non-contrast and RWR maps merged into a 2-channel (Model E), and delayed phase and RWR maps merged into a 2-channel (Model F). These input images were prepared manually with cropping and registration of CT images. Each DCNN model with six convolutional layers was trained with data augmentation and hyperparameter tuning. The optimal threshold values for binary classification were determined from the receiver-operating characteristic curve analyses. We adopted the nested cross-validation method, in which the outer fivefold cross-validation was used to assess the diagnostic performance of the models and the inner fivefold cross-validation was used to tune hyperparameters of the models. RESULTS: The areas under the curve with 95&#37; confidence intervals of Models A-F were 0.94 [0.90, 0.98], 0.80 [0.69, 0.89], 0.97 [0.94, 1.00], 0.92 [0.85, 0.97], 0.99 [0.97, 1.00] and 0.94 [0.86, 0.99], respectively. Model E showed high area under the curve greater than 0.95. CONCLUSION: DCNN models may be a useful tool for the diagnosis of AA using CT. ADVANCES IN KNOWLEDGE: The current study demonstrates a deep learning-based approach could differentiate adrenal adenoma from non-adenoma using multiphasic CT.

    DOI: 10.1259/bjr.20211066

  • Alterations of default mode and cingulo-opercular salience network and frontostriatal circuit: A candidate endophenotype of obsessive-compulsive disorder. International journal

    Hirofumi Tomiyama, Keitaro Murayama, Kiyotaka Nemoto, Suguru Hasuzawa, Taro Mizobe, Kenta Kato, Akira Matsuo, Aikana Ohno, Mingi Kang, Osamu Togao, Akio Hiwatashi, Kousei Ishigami, Tomohiro Nakao

    Progress in neuro-psychopharmacology & biological psychiatry   116   110516 - 110516   2022.6

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    Background It is gradually becoming clear that obsessive-compulsive disorder (OCD) patients have aberrant resting-state large-scale intrinsic networks of cingulo-opercular salience (SN), default mode (DMN), and front-parietal network (FPN). However, it remains unknown whether unaffected first-degree relatives of OCD patients have these alterations as a vulnerability marker to the disorder. Methods We performed resting-state functional magnetic resonance imaging (rsfMRI) scans of 47 medication-free OCD patients, 21 unaffected healthy first-degree relatives of OCD patients, and 62 healthy control (HC) participants. We explored differences between the three groups in the functional connectivity from SN (seeds: anterior-insula (AI) and dorsal anterior cingulate cortex (dACC)), DMN (seeds: medial prefrontal cortex (MPFC) and posterior parietal cortex (PCC)), and FPN (seeds: dorsolateral prefrontal cortex (DLPFC)). Results Compared to HC, both OCD patients and first-degree relatives showed significantly greater functional connectivity between AI and PCC and between DLPFC and the thalamus. Compared to first-degree relatives and HC, OCD patients showed reduced functional connectivity between PCC and DLPFC, and this altered functional connectivity was negatively correlated with anxiety and depressive symptom within OCD group. Conclusions OCD patients and unaffected first-degree relatives of OCD patients showed overlapping alterations in resting state functional connectivity between the regions of SN and DMN and between DLPFC and the thalamus. Our results suggested that alterations between large-scale intrinsic networks and within the dorsal cognitive cortico-striato-thalamo-cortical (CSTC) circuit could represent endophenotype markers of OCD.

    DOI: 10.1016/j.pnpbp.2022.110516

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

    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   304 ( 3 )   212584 - 212584   2022.5

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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&#37; CI: 0.6, 5.7; P = .01]; TBI-1: coefficient, 3.3 [95&#37; CI: 1.1, 5.6; P = .003]; TBI-2: coefficient, 7.6 [95&#37; CI: 4.0, 11; P < .001]; TBI-3: coefficient, 32 [95&#37; 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&#37; CI: 1.0, 1.9; P = .049]; TBI-2-3: HR, 3.8 [95&#37; 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.

    DOI: 10.1148/radiol.212584

  • Prediction of pathological response to preoperative chemotherapy for pancreatic ductal adenocarcinoma using 2-[18F]-fluoro-2-deoxy-d-glucose positron-emission tomography. International journal

    K Tabata, A Nishie, Y Shimomura, T Isoda, Y Kitamura, K Nakata, Y Yamada, Y Oda, K Ishigami, S Baba

    Clinical radiology   2022.4

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    AIM: To determine whether the pathological response to preoperative chemotherapy for pancreatic ductal adenocarcinoma (PDAC) can be predicted using 2-[18F]-fluoro-2-deoxy-d-glucose positron-emission tomography (F-18 FDG-PET). MATERIALS AND METHODS: Twenty-eight patients with PDAC who underwent only neoadjuvant chemotherapy (NAC) before surgery were enrolled in the study. All patients had F-18 FDG-PET examinations before NAC. The resected specimen was pathologically evaluated according to the Classification of Pancreatic Carcinoma (7th edn). Patients were categorised into a non-response group and a response group based on the pathological findings. The non-response group (Grades 1a and 1b) showed ≤50&#37; necrosis in the specimen, while the specimens of the response group (Grades 2-3) showed >50&#37; necrosis. The maximum standardised uptake values (SUVmax) of the tumours on F-18 FDG-PET were measured. The mean values of SUVmax were compared between the two groups. The diagnostic performance of SUVmax in distinguishing the two groups was also evaluated using receiver operating characteristic analysis. RESULTS: The mean SUVmax of the response group was higher than that of the non-response group (9.00 ± 1.78 versus 4.26 ± 2.35; p<0.001). The optimal cut-off value of SUVmax was 9.28 for distinguishing the two groups. The sensitivity, specificity, and accuracy for the prediction in the response group were 80&#37;, 95.7&#37;, and 92.9&#37;, respectively. CONCLUSIONS: SUVmax on F-18 FDG-PET may be useful as a biomarker to predict the pathological response to NAC in patients with PDAC.

    DOI: 10.1016/j.crad.2022.03.001

  • Diagnostic potential of T1ρ and T2 relaxations in assessing the severity of liver fibrosis and necro-inflammation. International journal

    Yukihisa Takayama, Akihiro Nishie, Keisuke Ishimatsu, Yasuhiro Ushijima, Nobuhiro Fujita, Yuichiro Kubo, Tomoharu Yoshizumi, Ken-Ichi Kouhashi, Junki Maehara, Yuta Akamine, Kousei Ishigami

    Magnetic resonance imaging   87   104 - 112   2022.4

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    PURPOSE: To investigate the utility of T1ρ and T2 relaxations for assessing the severity of liver fibrosis (F stage) and necro-inflammation (A stage) in patients with chronic liver disease (CLD). MATERIALS AND METHODS: We calculated T1ρ and T2 relaxations of the liver parenchyma in 82 patients who underwent liver surgery. F and A stages of enrolled patients were assessed by referring to surgically resected specimens. The relationships between T1ρ or T2 relaxation and F or A stage were assessed using one-way analysis of variance followed by Tukey's multiple comparison test, Spearman's rank correlation test and a receiver operating characteristic analysis. RESULTS: The T1ρ and T2 values of the liver parenchyma were significantly increased as the F and A stages progressed. The T1ρ and T2 values showed significant differences between F0 and F4, between F1 and F4, and between F2 and F4. In addition, T1ρ values showed a significant difference between F0 and F3 as well. The highest diagnostic ability for fibrosis was obtained when differentiating ≥F3 from ≤F2 using T1ρ: the sensitivity was 82.8&#37;, the specificity 79.2&#37; and the area under the curve (AUC) 0.87. The sensitivity and AUC of T1ρ relaxation (46.9&#37; and 0.67) were significantly higher than those of T2 relaxation (29.7&#37; and 0.60) for differentiating ≥A1 from A0. CONCLUSION: T1ρ and T2 relaxations have potential as a biochemical marker for assessing the severity of liver fibrosis and necro-inflammation. T1ρ relaxation may be slightly superior to T2 relaxation in terms of diagnostic ability for liver fibrosis and necro-inflammation.

    DOI: 10.1016/j.mri.2022.01.002

  • Impact of Nuclear Factor Erythroid 2-Related Factor 2 in Hepatocellular Carcinoma: Cancer Metabolism and Immune Status. International journal

    Norifumi Iseda, Shinji Itoh, Tomoharu Yoshizumi, Takahiro Tomiyama, Akinari Morinaga, Kyohei Yugawa, Masahiro Shimokawa, Tomonari Shimagaki, Huanlin Wang, Takeshi Kurihara, Yoshiyuki Kitamura, Yoshihiro Nagao, Takeo Toshima, Noboru Harada, Kenichi Kohashi, Shingo Baba, Kousei Ishigami, Yoshinao Oda, Masaki Mori

    Hepatology communications   6 ( 4 )   665 - 678   2022.4

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    We examined phosphorylated nuclear factor erythroid 2-related factor 2 (P-NRF2) expression in surgically resected primary hepatocellular carcinoma (HCC) and investigated the association of P-NRF2 expression with clinicopathological features and patient outcome. We also evaluated the relationship among NRF2, cancer metabolism, and programmed death ligand 1 (PD-L1) expression. In this retrospective study, immunohistochemical staining of P-NRF2 was performed on the samples of 335 patients who underwent hepatic resection for HCC. Tomography/computed tomography using fluorine-18 fluorodeoxyglucose was performed, and HCC cell lines after NRF2 knockdown were analyzed by array. We also analyzed the expression of PD-L1 after hypoxia inducible factor 1α (HIF1A) knockdown in NRF2-overexpressing HCC cell lines. Samples from 121 patients (36.1&#37;) were positive for P-NRF2. Positive P-NRF2 expression was significantly associated with high alpha-fetoprotein (AFP) expression, a high rate of poor differentiation, and microscopic intrahepatic metastasis. In addition, positive P-NRF2 expression was an independent predictor for recurrence-free survival and overall survival. NRF2 regulated glucose transporter 1, hexokinase 2, pyruvate kinase isoenzymes L/R, and phosphoglycerate kinase 1 expression and was related to the maximum standardized uptake value. PD-L1 protein expression levels were increased through hypoxia-inducible factor 1α after NRF2 overexpression in HCC cells. Conclusions: Our large cohort study revealed that P-NRF2 expression in cancer cells was associated with clinical outcome in HCC. Additionally, we found that NRF2 was located upstream of cancer metabolism and tumor immunity.

    DOI: 10.1002/hep4.1838

  • Importance of the heart rate in ultra-high-resolution coronary CT angiography with 0.35 s gantry rotation time

    Tsukasa Kojima, Takashi Shirasaka, Yuzo Yamasaki, Masatoshi Kondo, Hiroshi Hamasaki, Ryoji Mikayama, Yuki Sakai, Toyoyuki Kato, Akihiro Nishie, Kousei Ishigami, Hidetake Yabuuchi

    JAPANESE JOURNAL OF RADIOLOGY   2022.4

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    Purpose We investigated the effects of the heart rate (HR) on the motion artifact in coronary computed tomography angiography (CCTA) with ultra-high-resolution-CT (U-HRCT), and we clarified the upper limit of optimal HR in CCTA with U-HRCT in a comparison with conventional-resolution-CT (CRCT) on a cardiac phantom and in patients with CCTA.Materials and methods A pulsating cardiac phantom equipped with coronary models was scanned at static and HR simulations of 40-90 beats/min (bpm) at 10-bpm intervals using U-HRCT and CRCT, respectively. The sharpness and lumen diameter of the coronary model were quantitatively compared between U-HRCT and CRCT stratified by HR in the phantom study. We also assessed the visual inspections of clinical images in CCTA with U-HRCT.Results At the HRs <= 60 bpm, the error of the lumen diameter of the U-HRCT tended to be smaller than that of the CRCT. However, at the HRs > 60 bpm, the inverse was shown. For the image sharpness, the U-HRCT was significantly superior to the CRCT (p < 0.05). In the visual assessment, the scores were negatively correlated with HRs in patients (Spearman r= - 0.71, p < 0.01). A receiver-operating characteristic analysis revealed the HR of 61 bpm as the optimal cutoff of the non-diagnostic image quality, with an area under the curve of 0.87, 95&#37; sensitivity, and 71&#37; specificity.Conclusion At HRs <= 60 bpm, U-HRCT was more accurate in the imaging of coronary arteries than CRCT. The upper limit of the optimal HR in CCTA with U-HRCT was approx. 60 bpm.

    DOI: 10.1007/s11604-022-01265-2

  • Long-term follow up after sentinel node biopsy alone for early-stage cervical cancer. International journal

    Hideaki Yahata, Keisuke Kodama, Kaoru Okugawa, Kazuhisa Hachisuga, Nobuko Yasutake, Shoji Maenohara, Hiroshi Yagi, Masafumi Yasunaga, Tatsuhiro Ohgami, Ichiro Onoyama, Kazuo Asanoma, Hiroaki Kobayashi, Kenzo Sonoda, Shingo Baba, Kousei Ishigami, Yoshihiro Ohishi, Yoshinao Oda, Kiyoko Kato

    Gynecologic oncology   165 ( 1 )   149 - 154   2022.4

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    OBJECTIVE: Sentinel node biopsy alone (SNB) reduces the postoperative complications of pelvic lymphadenectomy, such as lymphedema and lymphangitis; however, the long-term prognosis after SNB is unclear. The objective of this study was to evaluate the long-term outcome and complications of patients with early-stage cervical cancer who underwent SNB for hysterectomy or trachelectomy. METHODS: We performed SNB for cervical cancer using a radioisotope method in 181 patients between 2009 and 2017. If the intraoperative sentinel lymph node evaluation was negative for metastasis, no further lymph nodes were removed. RESULTS: The median age of the patients was 34 years (range, 21-73 years). The International Federation of Gynecology and Obstetrics 2008 stage was IA1 in 6 patients, IA2 in 18, IB1 in 154, and IIA1 in 3. Of the 181 patients (44 with hysterectomy, 137 with trachelectomy), 8 did not undergo pelvic lymphadenectomy because of a false-negative intraoperative diagnosis, 20 received adjuvant therapy after surgery, and 4 (2.2&#37;) experienced recurrence over a median follow-up period of 83.5 months (range, 25-145 months). In the four recurrent cases, recurrence occurred in the pelvis, lung, and bone in one patient each, while the remaining patient developed pelvic and para-aortic lymph node metastases. Of these four patients, one died, and the remaining three are alive without disease after multidisciplinary therapy. The 5-year progression-free and overall survival rates were 98.8&#37; and 99.4&#37;, respectively. Postoperative complications, such as lymphedema, were very low rate. CONCLUSIONS: SNB for early-stage cervical cancer might be safe and effective, with no increase in the recurrence and postoperative complications rate.

    DOI: 10.1016/j.ygyno.2022.01.031

  • High-resolution magnetic resonance imaging of the triangular fibrocartilage complex using compressed sensing sensitivity encoding (SENSE)

    Fujiwara, H; Yabuuchi, H; Wada, T; Kobayashi, K; Hoshuyama, T; Kamitani, T; Ishigami, K

    EUROPEAN JOURNAL OF RADIOLOGY   149   110191   2022.4   ISSN:0720-048X eISSN:1872-7727

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    Purpose: To evaluate the optimal sequence for high-resolution magnetic resonance imaging (MRI) of the triangular fibrocartilage complex (TFCC) using compressed sensing-sensitivity encoding (CS-SENSE). Methods: Three-dimensional fast field echo T2-weighted images were obtained from 13 healthy volunteers using the original, high spatial resolution sequence with CS-SENSE [HR (CS-SENSE)] and without CS-SENSE (HR) and super-high spatial resolution sequence with CS-SENSE [S-HR (CS-SENSE)] and without CS-SENSE (S-HR). For qualitative analysis, the number of patients affected by motion artifacts in each sequence was counted, and the visualization of the TFCC anatomic structures and overall image quality were categorized. For the quantitative analysis, relative signal intensity (SI) and relative contrast of the lunate bone marrow, lunate cartilage, and disk proper in the wrist joint were all calculated. Results: The HR (CS-SENSE) sequence showed better visualization scores than the original sequence in the triangular ligament at the ulnar styloid tip, dorsal radioulnar ligament, and ulnotriquetral ligament. Similarly, the S-HR (CS-SENSE) sequence showed better visualization scores than the original sequence in the triangular ligament at the ulnar styloid tip and dorsal radioulnar ligament. Overall image quality scores were not significantly different, and motion artifacts in the HR and S-HR sequences were observed in 3 of the 13 patients. In contrast, the original sequence showed higher values than those in the HR (CS-SENSE) and S-HR (CS-SENSE) sequences in relative SI of the bone marrow and relative contrast of the cartilage-bone marrow and cartilage-disk proper. Conclusions: Out of the three sequences, the HR (CS-SENSE) sequence provided the highest visualization score and diagnostically sufficient image quality score, although relative SI and relative contrast were low. The HR (CS-SENSE) sequence may be clinically useful for imaging TFCCs.

    DOI: 10.1016/j.ejrad.2022.110191

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  • Improvement of the Visibility of Hepatocellular Carcinoma Lesions in Early Phase Abdominal Contrast Enhanced Computed Tomography Images: Utilization of Optimal Pseudo-Colorization

    AKAMINE Hiroshi, MORISHITA Junji, KURAMOTO Taku, HAMASAKI Hiroshi, TAKARABE Shinya, WADA Noriaki, ISHIMATSU Keisuke, USHIJIMA Yasuhiro, KATO Toyoyuki, ISHIGAMI Kousei, SASAKI Masayuki

    福岡醫學雜誌   113 ( 1 )   7 - 17   2022.3   ISSN:0016254X

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    Purpose : The specific objectives of our study were to examine whether the visibility of hepatocellular carcinoma (HCC) lesions on early phase abdominal contrast-enhanced computed tomography (CT) images can be improved by optimal pseudo-colorization with a rainbow color map. / Methods : The chromaticity of grayscale and rainbow color maps displayed on a medical liquid-crystal display was measured using a colorimeter. The differences in the chromaticity, bE00, between the HCC lesion and liver parenchyma in 22 cases were evaluated. The rainbow color map was revised by changing only the window level (WL) to match the HCC lesion with a peak of bE00. Visual evaluation of the 22 cases was performed using Scheffeʼs paired comparison by ten observers. The average psychological measurement (a) was calculated using the grayscale, rainbow color map, and revised rainbow color map to examine the effectiveness of the proposed method. / Results : In all cases, the a measure was highest in the order of revised rainbow, grayscale, and rainbow. These results indicate that the visibility of HCC lesions in early phase abdominal contrastenhanced CT images could be improved by modifying the pseudo-color map with optimal colorization based on bE00. / Conclusions : The visibility of HCC lesions in early phase abdominal contrast-enhanced CT images was improved by shifting only the WL setting so that the HCC contrast would match the pixel range with higher bE00 on the rainbow color map. This method can be applied to various cases and color maps, and the visibility of the target lesion can be easily improved.

    DOI: 10.15017/4795999

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  • 特集 局所進展とリンパ節転移に力点をおいた画像による癌の病期診断2022 6 胃

    鶴丸 大介, 高津 憲之, 甲斐 聖広, 石神 康生

    画像診断   42 ( 4 )   S84 - S93   2022.3   ISSN:02850524 eISSN:24321281

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    DOI: 10.15105/gz.0000002717

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  • 腹部造影CT動脈相における肝細胞癌病変の視認性の向上 最適な疑似カラー画像化の利用(Improvement of the Visibility of Hepatocellular Carcinoma Lesions in Early Phase Abdominal Contrast Enhanced Computed Tomography Images: Utilization of Optimal Pseudo-Colorization)

    赤嶺 寛地, 杜下 淳次, 倉本 卓, 濱崎 洋志, 寳部 真也, 和田 憲明, 石松 慶祐, 牛島 泰宏, 加藤 豊幸, 石神 康生, 佐々木 雅之

    福岡医学雑誌   113 ( 1 )   7 - 17   2022.3

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    【目的】本研究は、腹部造影コンピュータ断層撮影(CT)動脈相における肝細胞癌(HCC)病変の視認性が、rainbowカラーマップを使用した適切な疑似カラー画像化によって改善することを目的とした。【方法】医用画像表示用液晶ディスプレイに表示されるgrayscaleおよびrainbowカラーマップの色度を、色彩輝度計を使用して測定した。2017年4月から2019年12月までに腹部造影CT動脈相を撮影された22症例のHCC病変を対象とした。22症例において、HCC病変と肝実質の間の色度の違い(ΔE00)を評価した。適切なカラー画像化として、ウィンドウレベル(WL)のみを変更して、HCC病変のコントラストがRainbowカラーマップのΔE00の最も高いピクセル範囲に一致するようにRainbowカラーマップを修正した(revised rainbow)。10名の観察者によりScheffeの一対比較法を用いて22症例のHCC病変の視認性を評価した。提案した手法の有用性を調査するため、grayscale、rainbow、revised rainbowそれぞれにおいて、平均嗜好度(α)を求めた。【結果】すべての症例において(α)は、revised rainbow、grayscale、rainbowの順に高かった。これらの結果は、提案手法であるΔE00に基づいた適切な疑似カラー画像化によって、腹部造影CT動脈相におけるHCC病変の視認性を改善できることを示している。【結論】腹部造影CT動脈相におけるHCC病変の視認性は、HCC病変のコントラストがrainbowカラーマップ上のより高いΔE00のピクセル範囲と一致するようにWL設定のみをシフトすることによって改善された。本提案手法は、さまざまな症例やカラーマップに適用でき、標的病変の視認性を簡単に向上させることができる。(著者抄録)

  • Vessel-Selective 4D-MRA Using Superselective Pseudocontinuous Arterial Spin-Labeling with Keyhole and View-Sharing for Visualizing Intracranial Dural AVFs. International journal

    O Togao, M Obara, K Kikuchi, M Helle, K Arimura, A Nishimura, T Wada, H Murazaki, M Van Cauteren, A Hiwatashi, K Ishigami

    AJNR. American journal of neuroradiology   43 ( 3 )   368 - 375   2022.3   ISSN:0195-6108 eISSN:1936-959X

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    BACKGROUND AND PURPOSE: An accurate assessment of the hemodynamics of an intracranial dural AVF is necessary for treatment planning. We aimed to investigate the utility of 4D-MRA based on superselective pseudocontinuous arterial spin-labeling with CENTRA-keyhole and view-sharing (4D-S-PACK) for the vessel-selective visualization of intracranial dural AVFs. MATERIALS AND METHODS: We retrospectively analyzed the images of 21 patients (12 men and 9 women; mean age, 62.2 [SD,19.2] years) with intracranial dural AVFs, each of whom was imaged with DSA, 4D-S-PACK, and nonselective 4D-MRA based on pseudocontinuous arterial spin-labeling combined with CENTRA-keyhole and view-sharing (4D-PACK). The shunt location, venous drainage patterns, feeding artery identification, and Borden classification were evaluated by 2 observers using both MRA methods on separate occasions. Vessel selectivity was evaluated on 4D-S-PACK. RESULTS: Shunt locations were correctly evaluated in all 21 patients by both observers on both MRA methods. With 4D-S-PACK, observers 1 and 2 detected 76 (80.0%, P < .001) and 73 (76.8%, P < .001) feeding arteries of the 95 feeding arteries identified on DSA but only 39 (41.1%) and 46 (48.4%) feeding arteries with nonselective 4D-PACK, respectively. Both observers correctly identified 10 of the 11 patients with cortical venous reflux confirmed by DSA with both 4D-S-PACK and 4D-PACK (sensitivity = 90.9%, specificity = 90.9% for each method), and they made accurate Borden classifications in 20 of the 21 patients (95.2%) on both MRA methods. Of the 84 vessel territories examined, vessel selectivity was graded 3 or 4 in 73 (91.2%) and 66 (88.0%) territories by observers 1 and 2, respectively. CONCLUSIONS: 4D-S-PACK is useful for the identification of feeding arteries and accurate classifications of intracranial dural AVFs and can be a useful noninvasive clinical tool.

    DOI: 10.3174/ajnr.A7426

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  • Stratification of prostate cancer patients into low- and high-grade groups using multiparametric magnetic resonance radiomics with dynamic contrast-enhanced image joint histograms. International journal

    Akimasa Urakami, Hidetaka Arimura, Yukihisa Takayama, Fumio Kinoshita, Kenta Ninomiya, Kenjiro Imada, Sumiko Watanabe, Akihiro Nishie, Yoshinao Oda, Kousei Ishigami

    The Prostate   82 ( 3 )   330 - 344   2022.2

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    PURPOSE: This study aimed to investigate the potential of stratification of prostate cancer patients into low- and high-grade groups (GGs) using multiparametric magnetic resonance (mpMR) radiomics in conjunction with two-dimensional (2D) joint histograms computed with dynamic contrast-enhanced (DCE) images. METHODS: A total of 101 prostate cancer regions extracted from the MR images of 44 patients were identified and divided into training (n = 31 with 72 cancer regions) and test datasets (n = 13 with 29 cancer regions). Each dataset included low-grade tumors (International Society of Urological Pathology [ISUP] GG ≤ 2) and high-grade tumors (ISUP GG ≥ 3). A total of 137,970 features consisted of mpMR image (16 types of images in four sequences)-based and joint histogram (DCE images at 10 phases)-based features for each cancer region. Joint histogram features can visualize temporally changing perfusion patterns in prostate cancer based on the joint histograms between different phases or subtraction phases of DCE images. Nine signatures (a set of significant features related to GGs) were determined using the best combinations of features selected using the least absolute shrinkage and selection operator. Further, support vector machine models with the nine signatures were built based on a leave-one-out cross-validation for the training dataset and evaluated with receiver operating characteristic (ROC) curve analysis. RESULTS: The signature showing the best performance was constructed using six features derived from the joint histograms, DCE original images, and apparent diffusion coefficient maps. The areas under the ROC curves for the training and test datasets were 1.00 and 0.985, respectively. CONCLUSION: This study suggests that the proposed approach with mpMR radiomics in conjunction with 2D joint histogram computed with DCE images could have the potential to stratify prostate cancer patients into low- and high-GGs.

    DOI: 10.1002/pros.24278

  • Chronic thromboembolic pulmonary hypertension after acute pulmonary thromboembolism revealed by dynamic chest radiography. International journal

    Yuzo Yamasaki, Shohei Moriyama, Ryoma Tatsumoto, Kohtaro Abe, Kousei Ishigami

    European heart journal. Cardiovascular Imaging   2022.2

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    DOI: 10.1093/ehjci/jeac027

  • Gamma distribution model of diffusion MRI for evaluating the isocitrate dehydrogenase mutation status of glioblastomas. International journal

    Hanae Takase, Osamu Togao, Kazufumi Kikuchi, Nobuhiro Hata, Ryusuke Hatae, Toru Chikui, Kenji Tokumori, Yukiko Kami, Daisuke Kuga, Yuhei Sangatsuda, Masahiro Mizoguchi, Akio Hiwatashi, Kousei Ishigami

    The British journal of radiology   95 ( 1133 )   20210392 - 20210392   2022.2

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    OBJECTIVE: To determine whether the γ distribution (GD) model of diffusion MRI is useful in the evaluation of the isocitrate dehydrogenase (IDH) mutation status of glioblastomas. METHODS: 12 patients with IDH-mutant glioblastomas and 54 patients with IDH-wildtype glioblastomas were imaged with diffusion-weighted imaging using 13 b-values from 0 to 1000 s/mm2. The shape parameter (κ) and scale parameter (θ) were obtained with the GD model. Fractions of three different areas under the probability density function curve (f1, f2, f3) were defined as follows: f1, diffusion coefficient (D) < 1.0×10-3 mm2/s; f2, D > 1.0×10-3 and <3.0×10-3 mm2/s; f3, D > 3.0 × 10-3 mm2/s. The GD model-derived parameters measured in gadolinium-enhancing lesions were compared between the IDH-mutant and IDH-wildtype groups. Receiver operating curve analyses were performed to assess the parameters' diagnostic performances. RESULTS: The IDH-mutant group's f1 (0.474  ±  0.143) was significantly larger than the IDH-wildtype group's (0.347  ±  0.122, p = 0.0024). The IDH-mutant group's f2 (0.417  ±  0.131) was significantly smaller than the IDH-wildtype group's (0.504  ±  0.126, p = 0.036). The IDH-mutant group's f3 (0.109  ±  0.060) was significantly smaller than the IDH-wildtype group's (0.149  ±  0.063, p = 0.0466). The f1 showed the best diagnostic performance among the GD model-derived parameters with the area under the curve value of 0.753. CONCLUSION: The GD model could well describe the pathological features of IDH-mutant and IDH-wildtype glioblastomas, and was useful in the differentiation of these tumors. ADVANCES IN KNOWLEDGE: Diffusion MRI based on the γ distribution model could well describe the pathological features of IDH-mutant and IDH-wildtype glioblastomas, and its use enabled the significant differentiation of these tumors. The γ distribution model may contribute to the non-invasive identification of the IDH mutation status based on histological viewpoint.

    DOI: 10.1259/bjr.20210392

  • Optimization of 4D-MR angiography based on superselective pseudo-continuous arterial spin labeling combined with CENTRA-keyhole and view-sharing (4D-S-PACK) for vessel-selective visualization of the internal carotid artery and vertebrobasilar artery systems. International journal

    Hiroo Murazaki, Tatsuhiro Wada, Osamu Togao, Makoto Obara, Michael Helle, Yasuo Yamashita, Kouji Kobayashi, Akihiro Nishie, Kousei Ishigami, Toyoyuki Kato

    Magnetic resonance imaging   85   287 - 296   2022.1

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    PURPOSE: This study investigated the optimal labeling position and gradient moment for 4D-MR angiography based on superselective pseudo-continuous arterial spin labeling combined with CENTRA-keyhole and view-sharing (4D-S-PACK) for vessel-selective flow visualization of the internal carotid artery (ICA) and vertebrobasilar artery (VBA) systems. METHODS: Seven healthy volunteers were scanned with a 3.0 T MR scanner. To visualize the ICA system, the labeling focus was placed in the right ICA at 55, 75 and 95 mm below the imaging slab. To visualize the VBA system, the labeling focus was placed in the basilar artery (BA), upper vertebral artery (VA upper), and lower vertebral artery (VA lower). Two sizes of labeling focus were created using gradient moments of 0.5 and 0.75 mT/m ms. The contrast-to-noise ratio (CNR) was measured in the middle cerebral artery (MCA) and posterior cerebral artery (PCA) branches. RESULTS: CNRs increased as the distance between the center of the imaging slab and the labeling position decreased in all MCA segments. CNRs obtained with VA lower tended to be higher than those obtained with BA and VA upper in all PCA segments. Selective vessel visualization was achieved with the gradient moment of 0.75 mT/m ms for the ICA and VBA system. CONCLUSION: The optimal 4D-S-PACK gradient moment was found to be 0.75 mT/m ms for the ICA and VBA systems. When visualizing the ICA system, the labeling position should be placed as close as possible to the imaging slab. When visualizing the VBA system, the labeling position should be placed at VA lower .

    DOI: 10.1016/j.mri.2021.10.040

  • A deep convolutional neural network-based automatic detection of brain metastases with and without blood vessel suppression. International journal

    Yoshitomo Kikuchi, Osamu Togao, Kazufumi Kikuchi, Daichi Momosaka, Makoto Obara, Marc Van Cauteren, Alexander Fischer, Kousei Ishigami, Akio Hiwatashi

    European radiology   2022.1

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    OBJECTIVES: To develop an automated model to detect brain metastases using a convolutional neural network (CNN) and volume isotropic simultaneous interleaved bright-blood and black-blood examination (VISIBLE) and to compare its diagnostic performance with the observer test. METHODS: This retrospective study included patients with clinical suspicion of brain metastases imaged with VISIBLE from March 2016 to July 2019 to create a model. Images with and without blood vessel suppression were used for training an existing CNN (DeepMedic). Diagnostic performance was evaluated using sensitivity and false-positive results per case (FPs/case). We compared the diagnostic performance of the CNN model with that of the twelve radiologists. RESULTS: Fifty patients (30 males and 20 females; age range 29-86 years; mean 63.3 ± 12.8 years; a total of 165 metastases) who were clinically diagnosed with brain metastasis on follow-up were used for the training. The sensitivity of our model was 91.7&#37;, which was higher than that of the observer test (mean ± standard deviation; 88.7 ± 3.7&#37;). The number of FPs/case in our model was 1.5, which was greater than that by the observer test (0.17 ± 0.09). CONCLUSIONS: Compared to radiologists, our model created by VISIBLE and CNN to diagnose brain metastases showed higher sensitivity. The number of FPs/case by our model was greater than that by the observer test of radiologists; however, it was less than that in most of the previous studies with deep learning. KEY POINTS: • Our convolutional neural network based on bright-blood and black-blood examination to diagnose brain metastases showed a higher sensitivity than that by the observer test. • The number of false-positives/case by our model was greater than that by the previous observer test; however, it was less than those from most previous studies. • In our model, false-positives were found in the vessels, choroid plexus, and image noise or unknown causes.

    DOI: 10.1007/s00330-021-08427-2

  • Predictive factors of operability after neoadjuvant chemotherapy in resectable or borderline resectable pancreatic cancer: a single-center retrospective study. International journal

    Masatoshi Murakami, Nao Fujimori, Akihisa Ohno, Kazuhide Matsumoto, Katsuhito Teramatsu, Yu Takamatsu, Ayumu Takeno, Takamasa Oono, Toshiya Abe, Noboru Ideno, Naoki Ikenaga, Kohei Nakata, Masafumi Nakamura, Kousei Ishigami, Yoshihiro Ogawa

    Discover. Oncology   13 ( 1 )   2 - 2   2022.1

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    BACKGROUND/AIMS: Recently neoadjuvant chemotherapy (NAC) for pancreatic cancer has been shown to be superior to upfront surgery, but it remains a matter of debate for resectable cases. In clinical practice, some resectable cases may become unresectable after NAC. This study aimed to reveal the outcomes after NAC and to clarify the characteristics of unresected cases. METHODS: The medical records of 142 patients who underwent NAC between 2016 and 2020 were retrospectively reviewed. Patient characteristics, effectiveness of NAC, and outcomes were compared between the surgical group and non-surgical group (NSG). Furthermore, the risk of recurrence limited to in the patients who received NAC with gemcitabine plus nab-paclitaxel, which were mostly administered in this cohort, following R0/R1 resection was assessed. RESULTS: The overall and R0 resection rates after NAC were 89.1&#37; and 79.7&#37;, respectively. The neutrophil to lymphocyte ratio (NLR) > 2.78 (p = 0.0120) and anatomical borderline resectable pancreatic cancer (p = 0.0044) revealed a statistically significantly correlation with the NSG. On the other hand, NAC week < 8 (p = 0.0285), radiological response, stable disease or progression disease (p = 0.0212), and pathological stage > IIA (P = 0.0003) were significantly associated with recurrence. The tumor response rate was approximately 26.1&#37;, and three patients with ≥ 30&#37; reduction of primary tumor lost excision opportunities because of metastasis, interstitial pneumonia, and vascular invasion. CONCLUSIONS: This study shows incomplete tumor shrinkage benefits, but pre-NAC NLR is a predictive factor for predicting operability after NAC. The NLR can be easily calculated by normal blood test, and can be considered as a suitable marker of operability.

    DOI: 10.1007/s12672-021-00462-1

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

    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   6 ( 1 )   4 - 4   2022.1

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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 &#37; forced expiratory volume in one second (&#37;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 &#37;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.

    DOI: 10.1186/s41747-021-00254-w

  • Usefulness of semi-quantitative analysis in <SUP>123</SUP>I metaiodobenzylguanidine SPECT/CT for the differentiation of pheochromocytoma and cortical adenoma

    Kitamura, Y; Baba, S; Isoda, T; Maruoka, Y; Sasaki, M; Nishie, A; Ishigami, K

    ANNALS OF NUCLEAR MEDICINE   36 ( 1 )   95 - 102   2022.1   ISSN:0914-7187 eISSN:1864-6433

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    Objective: 123I metaiodobenzylguanidine (MIBG) scintigraphy is a useful tool for the diagnosis of pheochromocytomas (PHEOs), but some PHEOs are difficult to differentiate from cortical adenoma (CA) or normal adrenal uptake by visual evaluation alone. A new semi-quantitative analysis using 123I MIBG SPECT/CT is thus expected. Herein, we introduce the tumor-to-liver count ratio (T/L) and the tumor-to-muscle count ratio (T/M). Methods: We examined the cases of 21 patients with PHEOs (10 males, 11 females; age 24–80, median 61 years) and 23 patients with CA (15 males and 8 females, age 30–78, median 58 years). The visual scoring based on 123I MIBG planar images (planar score) and SPECT images (SPECT score) was used as the conventional evaluation. Using 123I MIBG SPECT/CT findings, we calculated the semi-quantitative values of the count ratio using the maximum or mean count of the tumor and the liver or muscle as the reference organ (T/Lmax, T/Lmean, T/Mmax and T/Mmean). Each evaluation of the PHEOs and CAs was compared, and the diagnosing performance was evaluated based on an ROC analysis. Results: The area under curve (AUC) values were as follows: the planar score, 0.833; SPECT score, 0.813; T/Lmax, 0.986; T/Lmean, 0.975; T/Mmax, 0.955; and T/Mmean, 0.933. The AUC for T/Mmax was significantly higher than those of the planar score, and SPECT score by ROC analysis (p < 0.01 each). Conclusion: The semi-quantitative value of 123I MIBG SPECT/CT is more useful than the conventional visual evaluation for differentiating PHEOs from CAs.

    DOI: 10.1007/s12149-021-01690-9

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  • Efficacy of Pre-operative 18F-FDG PET/CT in Prognostic Prediction in Patients With Renal Cell Carcinoma. International journal

    Masafumi Toguchi, Kousei Ishigami, Masato Goya, Seiichi Saito, Sadayuki Murayama, Akihiro Nishie

    Cancer diagnosis & prognosis   2 ( 2 )   216 - 222   2022

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    BACKGROUND/AIM: This study analyzed the parameters provided by preoperative 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for prognostic prediction of renal cell carcinoma (RCC). PATIENTS AND METHODS: FDG-PET/CT data from 66 clear cell RCC and 19 non-clear cell RCC cases between January 2015 and October 2018 were reviewed retrospectively. We compared the two groups according to recurrence/metastasis to determine prognosis-influencing factors. Multivariate Cox hazard regression models were constructed to evaluate factors potentially predicting disease-free survival (DFS) after adjustment for confounders. DFS was then compared between groups. RESULTS: Standardized uptake values (SUV) of the PET/CT scan were independent predictors of prognosis after adjusting for confounders. RCC cases were divided into two groups by optimal cut-off values. Differences between DFS percentages in high and low SUV groups were significant. Similar results were obtained in clear cell RCC groups. CONCLUSION: Increased SUV of the PET/CT scan are significant predictors of worse prognoses in patients with surgically resected RCC.

    DOI: 10.21873/cdp.10097

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  • Dosimetry of Occupational Eye Lens Dose Using a Novel Direct Eye Dosimeter, DOSIRIS, during Interventional Radiology Procedures

    Hirakawa, M; Nakatake, H; Tsuruta, S; Matsuura, S; Motomura, Y; Hiraki, Y; Mimori, K; Ishigami, K

    INTERVENTIONAL RADIOLOGY   7 ( 2 )   40 - 43   2022   eISSN:2432-0935

  • COVID-19 Vaccination reduced pneumonia severity

    Wada, N; Li, Y; Hino, T; Gagne, S; Valtchinov, VI; Gay, E; Nishino, M; Madore, B; Guttmann, CRG; Bond, S; Ishigami, K; Hunninghake, GM; Levy, BD; Kaye, KM; Christiani, DC; Hatabu, H

    EUROPEAN JOURNAL OF RADIOLOGY OPEN   9   100456   2022   ISSN:2352-0477 eISSN:2352-0477

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    Purpose: To investigate the effect of vaccinations and boosters on the severity of COVID-19 pneumonia on CT scans during the period of Delta and Omicron variants. Methods: Retrospectively studied were 303 patients diagnosed with COVID-19 between July 2021 and February 2022, who had obtained at least one CT scan within 6 weeks around the COVID-19 diagnosis (−2 to +4 weeks). The severity of pneumonia was evaluated with a 6-point scale Pneumonia Score. The association between demographic and clinical data and vaccination status (booster/additional vaccination, complete vaccination and un-vaccination) and the difference between Pneumonia Scores by vaccination status were investigated. Results: Of 303 patients (59.4 ± 16.3 years; 178 females), 62 (20 %) were in the booster/additional vaccination group, 117 (39 %) in the complete vaccination group, and 124 (41 %) in the unvaccinated group. Interobserver agreement of the Pneumonia Score was high (weighted kappa score = 0.875). Patients in the booster/additionally vaccinated group tended to be older (P = 0.0085) and have more underlying comorbidities (P < 0.0001), and the Pneumonia Scores were lower in the booster/additionally vaccinated [median 2 (IQR 0–4)] and completely vaccinated groups [median 3 (IQR 1–4)] than those in the unvaccinated group [median 4 (IQR 2–4)], respectively (P < 0.0001 and P < 0.0001, respectively). A multivariable linear analysis adjusted for confounding factors confirmed the difference. Conclusion: Vaccinated patients, with or without booster/additional vaccination, had milder COVID-19 pneumonia on CT scans than unvaccinated patients during the period of Delta and Omicron variants. This study supports the efficacy of the vaccine against COVID-19 from a radiological perspective.

    DOI: 10.1016/j.ejro.2022.100456

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  • Alveolar soft part sarcoma of the orbit: A case report. International journal

    Takeshi Oda, Kazufumi Kikuchi, Osamu Togao, Shingo Baba, Masahiro Mizoguchi, Mika Tanabe, Mamoru Ito, Hidetaka Yamamoto, Kousei Ishigami, Akio Hiwatashi

    Radiology case reports   16 ( 12 )   3766 - 3771   2021.12

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    Alveolar soft part sarcoma is a rare soft tissue neoplasm that accounts for approximately 1&#37; of all sarcomas and is usually identified in the extremities in adults. The occurrence of alveolar soft part sarcoma in the orbit is extremely rare, estimated at approximately 5&#37; - 15&#37; among all cases of alveolar soft part sarcoma . Here, we present a case of 29-year-old woman with orbital alveolar soft part sarcoma. We describe the magnetic resonance and F-18 2-fluoro-2-deoxy-D-glucose-position emission tomography/computed tomography findings of this case. This young woman had a spindle-shaped mass. A higher signal compared to the extraocular muscle on T1-weighted images, numerous flow voids on T2-weighted images, and intense enhancement could be key findings of this disease.

    DOI: 10.1016/j.radcr.2021.09.005

  • Measurement of circumferential tumor extent of colorectal cancer on CT colonography: relation to clinicopathological features and patient prognosis after surgery.

    Daisuke Tsurumaru, Noriyuki Takatsu, Satohiro Kai, Eiji Oki, Kousei Ishigami

    Japanese journal of radiology   39 ( 10 )   966 - 972   2021.10

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    PURPOSE: To examine the relationship between circumferential tumor extent of colorectal cancer (CRC) on CT colonography (CTC) and clinicopathological features including patient prognosis after surgery. MATERIALS AND METHODS: This retrospective study performed at our institution from January 2013 to December 2019 enrolled 195 consecutive patients (110 men, 85 women; mean age, 64.7 years) with CRC evaluated by contrast-enhanced CTC before surgery. The circumferential tumor extent rate (CER) was measured by CTC in virtual colon dissection (VCD) mode to examine the relation between the CER and clinicopathological features and patient prognosis. RESULTS: CER had association with tumor invasion depth (T), nodal involvement (N), distant metastasis (M), and stage. The Kruskal-Wallis tests showed significant difference for T, N and the stage (p < 0.0001, p = 0.0021 and p < 0.0001) and Wilcoxon rank sum test showed significant difference for M (p = 0.0015). According to the log-rank test, there were no significant differences in OS or DFS between patients with high and low CER. CONCLUSION: Circumferential tumor extent was significantly correlated with TNM categories and stage of CRC, but not with patient prognosis after surgery.

    DOI: 10.1007/s11604-021-01141-5

  • Measurement of circumferential tumor extent of colorectal cancer on CT colonography: relation to clinicopathological features and patient prognosis after surgery.

    Daisuke Tsurumaru, Noriyuki Takatsu, Satohiro Kai, Eiji Oki, Kousei Ishigami

    Japanese journal of radiology   39 ( 10 )   966 - 972   2021.10

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    PURPOSE: To examine the relationship between circumferential tumor extent of colorectal cancer (CRC) on CT colonography (CTC) and clinicopathological features including patient prognosis after surgery. MATERIALS AND METHODS: This retrospective study performed at our institution from January 2013 to December 2019 enrolled 195 consecutive patients (110 men, 85 women; mean age, 64.7 years) with CRC evaluated by contrast-enhanced CTC before surgery. The circumferential tumor extent rate (CER) was measured by CTC in virtual colon dissection (VCD) mode to examine the relation between the CER and clinicopathological features and patient prognosis. RESULTS: CER had association with tumor invasion depth (T), nodal involvement (N), distant metastasis (M), and stage. The Kruskal-Wallis tests showed significant difference for T, N and the stage (p < 0.0001, p = 0.0021 and p < 0.0001) and Wilcoxon rank sum test showed significant difference for M (p = 0.0015). According to the log-rank test, there were no significant differences in OS or DFS between patients with high and low CER. CONCLUSION: Circumferential tumor extent was significantly correlated with TNM categories and stage of CRC, but not with patient prognosis after surgery.

    DOI: 10.1007/s11604-021-01141-5

  • The Evolving Genomic Landscape of Esophageal Squamous Cell Carcinoma Under Chemoradiotherapy. International journal

    Hidenari Hirata, Atsushi Niida, Nobuyuki Kakiuchi, Ryutaro Uchi, Keishi Sugimachi, Takaaki Masuda, Tomoko Saito, Shun-Ichiro Kageyama, Yushi Motomura, Shuhei Ito, Tadamasa Yoshitake, Daisuke Tsurumaru, Yusuke Nishimuta, Akira Yokoyama, Takanori Hasegawa, Kenichi Chiba, Yuichi Shiraishi, Junyan Du, Fumihito Miura, Masaru Morita, Yasushi Toh, Masakazu Hirakawa, Yoshiyuki Shioyama, Takashi Ito, Tetsuo Akimoto, Satoru Miyano, Tatsuhiro Shibata, Masaki Mori, Yutaka Suzuki, Seishi Ogawa, Kousei Ishigami, Koshi Mimori

    Cancer research   81 ( 19 )   4926 - 4938   2021.10

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    Esophageal squamous cell carcinoma (ESCC) often recurs after chemoradiotherapy, and the prognosis of ESCC after chemoradiotherapy has not improved over the past few decades. The mutation process in chemoradiotherapy-resistant clones and the functional relevance of genetic alterations remain unclear. To address these problems, we performed whole-exome sequencing of 52 tumor samples from 33 patients with ESCC who received radiotherapy combined with 5-fluorouracil/platinum. In multiregion analyses of pretreatment and locally recurrent lesions from five cases, most driver gene-altered clones remained under chemoradiotherapy selection pressure, while few driver gene alterations were acquired at recurrence. The mutation signatures of recurrent ESCC, including increased deletion frequency and platinum dose-dependent base substitution signatures, were substantially different from those of primary ESCC and reflected the iatrogenic impacts of chemoradiotherapy. Single-region analysis of 28 pretreatment tumors indicated that focal copy-number gain at the MYC locus was significantly associated with poor progression-free survival and overall survival after chemoradiotherapy. MYC gain remained throughout the chemoradiotherapy course and potentially contributes to intrinsic resistance to chemoradiotherapy. Consistent with these findings, MYC copy number and mRNA and protein levels in ESCC cell lines correlated positively with resistance to radiotherapy, and MYC knockdown improved sensitivity to radiotherapy. Overall, these data characterize the clonal evolution process induced by chemoradiotherapy and clinically relevant associations for genetic alterations in ESCC. These findings increase our understanding of therapeutic resistance and support the rationale for precision chemoradiotherapy. SIGNIFICANCE: Whole-exome sequencing reveals the genetic evolution of ESCC during chemoradiotherapy, highlighting MYC gain in pretreatment tumors as a potential marker of therapy resistance.

    DOI: 10.1158/0008-5472.CAN-21-0653

  • Unchanged right ventricular strain in repaired tetralogy of Fallot after pulmonary valve replacement with radial long-axis cine magnetic resonance images. International journal

    Masateru Kawakubo, Yuzo Yamasaki, Daisuke Toyomura, Kenichiro Yamamura, Ichiro Sakamoto, Tetsuhiro Moriyama, Hidetake Yabuuchi, Kousei Ishigami

    Scientific reports   11 ( 1 )   18879 - 18879   2021.9

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    We measured right ventricular (RV) strain by applying a novel postprocessing technique to conventional short-axis cine magnetic resonance imaging in the repaired tetralogy of Fallot (TOF) and investigated whether pulmonary valve replacement (PVR) changes the RV strain. Twenty-four patients with repaired TOF who underwent PVR and 16 healthy controls were enrolled. Global maximum and minimum principal strains (GPSmax, GPSmin) and global circumferential and longitudinal strains (GCS, GLS) were measured from short-axis cine images reconstructed radially along the long axis. Strain parameters before and after PVR were compared using paired t-tests. One-way ANOVA with Tukey post-hoc analysis was used for comparisons between the before and after PVR groups and the control group. There were no differences in strain parameters before and after PVR. The GPSmax before PVR was lower than that in the control group (P = 0.002). Before and after PVR, GCSs were higher and GLSs were lower than those in the control group (before and after GCSs: P = 0.002 for both, before and after GLSs: P < 0.0001 and P = 0.0003). RV strains from radially reconstructed short-axis cine images revealed unchanged myocardial motion after PVR. When compared to the control group, changes in GCS and GLS in TOF patients before and after PVR might be due to RV remodeling.

    DOI: 10.1038/s41598-021-98464-0

  • Evaluation of MR imaging findings differentiating parotid basal cell adenomas from other parotid tumors. International journal

    Yuriko Murayama, Takeshi Kamitani, Koji Sagiyama, Yuzo Yamasaki, Tomoyuki Hida, Yuko Matsuura, Ryuji Yasumatsu, Hidetaka Yamamoto, Hidetake Yabuuchi, Kousei Ishigami

    European journal of radiology   144   109980 - 109980   2021.9

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    PURPOSE: To evaluate the usefulness of magnetic resonance imaging (MRI) to differentiate basal cell adenomas (BCAs) from other parotid tumors. METHOD: A total of 136 patients with histologically proven parotid gland tumors (13 BCAs, 66 pleomorphic adenomas [PAs], 30 Warthin tumors [WTs], and 27 parotid cancers [PCs]) who underwent a cervical MRI study between December 2011 and March 2019 were retrospectively enrolled. The MRI findings of the tumors were evaluated by two board-certified radiologists. RESULTS: All 13 of the BCAs showed smooth margins, while 19 of the 27 PCs showed irregular margins (p < 0.0001). Eleven BCAs had some cystic components, and five were cyst-dominant. The BCAs had significantly more cystic components than the PAs (p = 0.0077). The mean apparent diffusion coefficient (ADC) value of the BCAs was 1.21 ± 0.20 × 10-3 mm2/sec, which was equivalent to that of the PCs (1.12 ± 0.25 × 10-3 mm2/sec, p = 0.76), significantly lower than that of the PAs (1.61 ± 0.32 × 10-3 mm2/sec, p < 0.0001), and significantly higher than that of the WTs (0.81 ± 0.19 × 10-3 mm2/sec, p = 0.0004). The plateau time-intensity curve (TIC) was the most common type for both BCAs and PCs, seen in 8 of 12 BCAs and 21 of 26 PCs, with no significant difference between these groups (p = 0.34). CONCLUSIONS: BCA should be considered a possibility when a parotid lesion has smooth margins with an entire capsule and includes a cystic component, even if the TIC and diffusion-weighted MR images suggest a malignant pattern.

    DOI: 10.1016/j.ejrad.2021.109980

  • Unchanged right ventricular strain in repaired tetralogy of Fallot after pulmonary valve replacement with radial long-axis cine magnetic resonance images. International journal

    Masateru Kawakubo, Yuzo Yamasaki, Daisuke Toyomura, Kenichiro Yamamura, Ichiro Sakamoto, Tetsuhiro Moriyama, Hidetake Yabuuchi, Kousei Ishigami

    Scientific reports   11 ( 1 )   18879 - 18879   2021.9

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    We measured right ventricular (RV) strain by applying a novel postprocessing technique to conventional short-axis cine magnetic resonance imaging in the repaired tetralogy of Fallot (TOF) and investigated whether pulmonary valve replacement (PVR) changes the RV strain. Twenty-four patients with repaired TOF who underwent PVR and 16 healthy controls were enrolled. Global maximum and minimum principal strains (GPSmax, GPSmin) and global circumferential and longitudinal strains (GCS, GLS) were measured from short-axis cine images reconstructed radially along the long axis. Strain parameters before and after PVR were compared using paired t-tests. One-way ANOVA with Tukey post-hoc analysis was used for comparisons between the before and after PVR groups and the control group. There were no differences in strain parameters before and after PVR. The GPSmax before PVR was lower than that in the control group (P = 0.002). Before and after PVR, GCSs were higher and GLSs were lower than those in the control group (before and after GCSs: P = 0.002 for both, before and after GLSs: P < 0.0001 and P = 0.0003). RV strains from radially reconstructed short-axis cine images revealed unchanged myocardial motion after PVR. When compared to the control group, changes in GCS and GLS in TOF patients before and after PVR might be due to RV remodeling.

    DOI: 10.1038/s41598-021-98464-0

  • Evaluation of MR imaging findings differentiating parotid basal cell adenomas from other parotid tumors. International journal

    Yuriko Murayama, Takeshi Kamitani, Koji Sagiyama, Yuzo Yamasaki, Tomoyuki Hida, Yuko Matsuura, Ryuji Yasumatsu, Hidetaka Yamamoto, Hidetake Yabuuchi, Kousei Ishigami

    European journal of radiology   144   109980 - 109980   2021.9

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    PURPOSE: To evaluate the usefulness of magnetic resonance imaging (MRI) to differentiate basal cell adenomas (BCAs) from other parotid tumors. METHOD: A total of 136 patients with histologically proven parotid gland tumors (13 BCAs, 66 pleomorphic adenomas [PAs], 30 Warthin tumors [WTs], and 27 parotid cancers [PCs]) who underwent a cervical MRI study between December 2011 and March 2019 were retrospectively enrolled. The MRI findings of the tumors were evaluated by two board-certified radiologists. RESULTS: All 13 of the BCAs showed smooth margins, while 19 of the 27 PCs showed irregular margins (p < 0.0001). Eleven BCAs had some cystic components, and five were cyst-dominant. The BCAs had significantly more cystic components than the PAs (p = 0.0077). The mean apparent diffusion coefficient (ADC) value of the BCAs was 1.21 ± 0.20 × 10-3 mm2/sec, which was equivalent to that of the PCs (1.12 ± 0.25 × 10-3 mm2/sec, p = 0.76), significantly lower than that of the PAs (1.61 ± 0.32 × 10-3 mm2/sec, p < 0.0001), and significantly higher than that of the WTs (0.81 ± 0.19 × 10-3 mm2/sec, p = 0.0004). The plateau time-intensity curve (TIC) was the most common type for both BCAs and PCs, seen in 8 of 12 BCAs and 21 of 26 PCs, with no significant difference between these groups (p = 0.34). CONCLUSIONS: BCA should be considered a possibility when a parotid lesion has smooth margins with an entire capsule and includes a cystic component, even if the TIC and diffusion-weighted MR images suggest a malignant pattern.

    DOI: 10.1016/j.ejrad.2021.109980

  • Dynamic Chest Radiography of Pulmonary Arteriovenous Malformation. International journal

    Yuzo Yamasaki, Kousei Ishigami

    Radiology   300 ( 2 )   285 - 285   2021.8

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    Online supplemental material is available for this article.

    DOI: 10.1148/radiol.2021204631

  • A case of KIT negative extra-gastrointestinal stromal tumor arising in the greater omentum with predominant cystic formation. International journal

    Katsuya Nanjo, Yusuke Nishimuta, Mitsutoshi Miyasaka, Kenji Shinozaki, Daisuke Tsurumaru, Kousei Ishigami

    Radiology case reports   16 ( 8 )   2315 - 2318   2021.8

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    We report a rare case of KIT-negative extra-gastrointestinal stromal tumor, in a 40-year-old woman. Contrast-enhanced computed tomography and magnetic resonance imaging revealed a >15-cm mass of multiple cystic lesions in the greater omentum. Histopathological findings after surgery showed a sheet-like growth of stellate tumor cells from epithelial cells, cystic degeneration, and mucus-like stroma. Immunohistochemistry was positive for discovered on GIST-1 (DOG1) but negative for CD117 (c-kit).

    DOI: 10.1016/j.radcr.2021.05.061

  • Papillary craniopharyngioma coexisting with an intratumoral abscess in a pediatric patient: A case report and review of the literature. International journal

    Katsuhiro Takagi, Kazufumi Kikuchi, Akio Hiwatashi, Osamu Togao, Yuhei Sangatsuda, Daisuke Kuga, Masahiro Mizoguchi, Hidetaka Yamamoto, Toru Iwaki, Kousei Ishigami

    Acta radiologica open   10 ( 7 )   20584601211030661 - 20584601211030661   2021.7

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    Craniopharyngiomas are benign neoplasms with two histological subtypes: adamantinomatous and papillary. Papillary craniopharyngiomas are rare in children, and those with a pituitary abscess within are even rarer. Herein, we present the case of a 14-year-old boy with a papillary craniopharyngioma and a coexisting intratumoral abscess, who was hospitalized for persistent pyrexia, polyuria, and polydipsia. The absence of calcification on computed tomography, high signal intensity inside the tumor on diffusion-weighted imaging, and clinical findings such as fever, a high inflammatory response, and meningitis, as well as short-term morphological changes on imaging, could aid in diagnosis.

    DOI: 10.1177/20584601211030661

  • Impact and risk factors for skeletal muscle mass loss after hepatic resection in patients with hepatocellular carcinoma. International journal

    Shinji Itoh, Tomoharu Yoshizumi, Takahiro Tomiyama, Norifumi Iseda, Akinari Morinaga, Tomonari Shimagaki, Huanlin Wang, Takeshi Kurihara, Yoshihiro Nagao, Takeo Toshima, Noboru Harada, Akihiro Nishie, Kousei Ishigami, Masaki Mori

    JGH open : an open access journal of gastroenterology and hepatology   5 ( 7 )   785 - 792   2021.7

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    Background and Aim: The aims of this study were to determine whether a postoperative decrease in skeletal muscle mass (SMM) after hepatic resection can predict long-term outcomes in patients with hepatocellular carcinoma (HCC) and identify risk factors for SMM loss in patients who undergo hepatic resection. Methods: This was a large retrospective study of 400 patients who underwent hepatic resection for HCC and pre- and postoperative computed tomography (CT) scans. SMM was measured at the third lumbar vertebrae, and the postoperative change in SMM compared with preoperative values was calculated as Δ SMM. The cutoff value for the post-/preoperative ratio was set at 0.9. Results: Sixty patients (15.0%) developed SMM loss. These patients had a significantly prolonged prothrombin time (P = 0.0092), longer duration of surgery (P = 0.0021), more blood loss (P = 0.0040), and higher rate of postoperative complications (P = 0.0037) than those without SMM loss. Multivariate analysis revealed that prolonged prothrombin time and postoperative complications were independent risk factors for SMM loss after hepatic resection. Patients with SMM loss had significantly shorter overall survival (P = 0.0018) than the other patients had. SMM loss was an independent prognostic factor for overall survival (hazard ratio 1.551, 95% confidential interval 1.028-2.340, P = 0.0363). Conclusions: We demonstrated an association of SMM loss with postoperative complications and long-term prognosis in patients with HCC. Patients with prolonged prothrombin time, or postoperative complications, may need to maintain their SMM. Further prospective studies are needed to investigate whether nutritional support can improve SMM loss.

    DOI: 10.1002/jgh3.12588

  • Impact of Metabolic Activity in Hepatocellular Carcinoma: Association With Immune Status and Vascular Formation. International journal

    Shinji Itoh, Tomoharu Yoshizumi, Yoshiyuki Kitamura, Kyohei Yugawa, Norifumi Iseda, Tomonari Shimagaki, Yoshihiro Nagao, Takeo Toshima, Noboru Harada, Kenichi Kohashi, Shingo Baba, Kousei Ishigami, Yoshinao Oda, Masaki Mori

    Hepatology communications   5 ( 7 )   1278 - 1289   2021.7

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    We evaluated the prognostic value of fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in hepatocellular carcinoma (HCC). Their association with programmed death ligand 1 (PD-L1) expression and vascular formation was further investigated. In this retrospective study, using a database of 418 patients who had undergone 18F-FDG PET/CT before hepatic resection for HCC, immunohistochemical staining of PD-L1, clusters of differentiation (CD) 8, CD68, and CD34 was performed. Patients with a high maximum standardized uptake value (SUVmax) on 18F-FDG PET/CT showed a significantly worse recurrence-free survival (RFS) (hazard ratio [HR]: 1.500; 95% confidence interval [CI]: 1.088-2.069; P = 0.0133) and overall survival (OS) (HR: 2.259; 95% CI: 1.276-4.000; P = 0.0052) than patients with a low SUVmax. Logistic regression analysis showed that a high SUVmax in HCC was significantly associated with PD-L1-positive expression (odds ratio: 4.407; 95% CI: 2.265-8.575; P < 0.0001). SUVmax values of HCC were associated with intratumoral CD8-positive T-cell counts (P = 0.0044) and CD68-positive macrophage counts (P = 0.0061). Stratification based on SUVmax, PD-L1 expression, and the vessels that encapsulate tumor clusters (VETC) status was also significantly associated with RFS and OS. SUVmax, VETC, and PDL1 expression were independently predictive of survival on multivariable analysis. Conclusion: Our large cohort study showed that a high SUVmax on 18F-FDG PET/CT is associated with a poor clinical outcome and PD-L1 expression in patients with HCC. Additionally, stratification of patients based on the combination of SUVmax, PD-L1 expression, and the VETC status predicts poor clinical outcome.

    DOI: 10.1002/hep4.1715

  • Papillary craniopharyngioma coexisting with an intratumoral abscess in a pediatric patient: A case report and review of the literature. International journal

    Katsuhiro Takagi, Kazufumi Kikuchi, Akio Hiwatashi, Osamu Togao, Yuhei Sangatsuda, Daisuke Kuga, Masahiro Mizoguchi, Hidetaka Yamamoto, Toru Iwaki, Kousei Ishigami

    Acta radiologica open   10 ( 7 )   20584601211030661 - 20584601211030661   2021.7

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    Craniopharyngiomas are benign neoplasms with two histological subtypes: adamantinomatous and papillary. Papillary craniopharyngiomas are rare in children, and those with a pituitary abscess within are even rarer. Herein, we present the case of a 14-year-old boy with a papillary craniopharyngioma and a coexisting intratumoral abscess, who was hospitalized for persistent pyrexia, polyuria, and polydipsia. The absence of calcification on computed tomography, high signal intensity inside the tumor on diffusion-weighted imaging, and clinical findings such as fever, a high inflammatory response, and meningitis, as well as short-term morphological changes on imaging, could aid in diagnosis.

    DOI: 10.1177/20584601211030661

  • Impact and risk factors for skeletal muscle mass loss after hepatic resection in patients with hepatocellular carcinoma. International journal

    Shinji Itoh, Tomoharu Yoshizumi, Takahiro Tomiyama, Norifumi Iseda, Akinari Morinaga, Tomonari Shimagaki, Huanlin Wang, Takeshi Kurihara, Yoshihiro Nagao, Takeo Toshima, Noboru Harada, Akihiro Nishie, Kousei Ishigami, Masaki Mori

    JGH open : an open access journal of gastroenterology and hepatology   5 ( 7 )   785 - 792   2021.7

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    Background and Aim: The aims of this study were to determine whether a postoperative decrease in skeletal muscle mass (SMM) after hepatic resection can predict long-term outcomes in patients with hepatocellular carcinoma (HCC) and identify risk factors for SMM loss in patients who undergo hepatic resection. Methods: This was a large retrospective study of 400 patients who underwent hepatic resection for HCC and pre- and postoperative computed tomography (CT) scans. SMM was measured at the third lumbar vertebrae, and the postoperative change in SMM compared with preoperative values was calculated as Δ SMM. The cutoff value for the post-/preoperative ratio was set at 0.9. Results: Sixty patients (15.0&#37;) developed SMM loss. These patients had a significantly prolonged prothrombin time (P = 0.0092), longer duration of surgery (P = 0.0021), more blood loss (P = 0.0040), and higher rate of postoperative complications (P = 0.0037) than those without SMM loss. Multivariate analysis revealed that prolonged prothrombin time and postoperative complications were independent risk factors for SMM loss after hepatic resection. Patients with SMM loss had significantly shorter overall survival (P = 0.0018) than the other patients had. SMM loss was an independent prognostic factor for overall survival (hazard ratio 1.551, 95&#37; confidential interval 1.028-2.340, P = 0.0363). Conclusions: We demonstrated an association of SMM loss with postoperative complications and long-term prognosis in patients with HCC. Patients with prolonged prothrombin time, or postoperative complications, may need to maintain their SMM. Further prospective studies are needed to investigate whether nutritional support can improve SMM loss.

    DOI: 10.1002/jgh3.12588

  • Impact of Metabolic Activity in Hepatocellular Carcinoma: Association With Immune Status and Vascular Formation. International journal

    Shinji Itoh, Tomoharu Yoshizumi, Yoshiyuki Kitamura, Kyohei Yugawa, Norifumi Iseda, Tomonari Shimagaki, Yoshihiro Nagao, Takeo Toshima, Noboru Harada, Kenichi Kohashi, Shingo Baba, Kousei Ishigami, Yoshinao Oda, Masaki Mori

    Hepatology communications   5 ( 7 )   1278 - 1289   2021.7

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    We evaluated the prognostic value of fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in hepatocellular carcinoma (HCC). Their association with programmed death ligand 1 (PD-L1) expression and vascular formation was further investigated. In this retrospective study, using a database of 418 patients who had undergone 18F-FDG PET/CT before hepatic resection for HCC, immunohistochemical staining of PD-L1, clusters of differentiation (CD) 8, CD68, and CD34 was performed. Patients with a high maximum standardized uptake value (SUVmax) on 18F-FDG PET/CT showed a significantly worse recurrence-free survival (RFS) (hazard ratio [HR]: 1.500; 95&#37; confidence interval [CI]: 1.088-2.069; P = 0.0133) and overall survival (OS) (HR: 2.259; 95&#37; CI: 1.276-4.000; P = 0.0052) than patients with a low SUVmax. Logistic regression analysis showed that a high SUVmax in HCC was significantly associated with PD-L1-positive expression (odds ratio: 4.407; 95&#37; CI: 2.265-8.575; P < 0.0001). SUVmax values of HCC were associated with intratumoral CD8-positive T-cell counts (P = 0.0044) and CD68-positive macrophage counts (P = 0.0061). Stratification based on SUVmax, PD-L1 expression, and the vessels that encapsulate tumor clusters (VETC) status was also significantly associated with RFS and OS. SUVmax, VETC, and PDL1 expression were independently predictive of survival on multivariable analysis. Conclusion: Our large cohort study showed that a high SUVmax on 18F-FDG PET/CT is associated with a poor clinical outcome and PD-L1 expression in patients with HCC. Additionally, stratification of patients based on the combination of SUVmax, PD-L1 expression, and the VETC status predicts poor clinical outcome.

    DOI: 10.1002/hep4.1715

  • Diagnosis of Pulmonary Hypertension Using Dynamic Chest Radiography. International journal

    Yuzo Yamasaki, Takeshi Kamitani, Kohtaro Abe, Kazuya Hosokawa, Koji Sagiyama, Tomoyuki Hida, Yuko Matsuura, Yoshiyuki Kitamura, Yasuhiro Maruoka, Takuro Isoda, Shingo Baba, Hideki Yoshikawa, Taku Kuramoto, Hidetake Yabuuchi, Kousei Ishigami

    American journal of respiratory and critical care medicine   204 ( 11 )   1336 - 1337   2021.6

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    DOI: 10.1164/rccm.202102-0387IM

  • Congestion Area of the Right Lobe Graft in Living Donor Liver Transplantation: Quantitative Evaluation of Hemodynamics Using Computed Tomography Perfusion. International journal

    Koichiro Morita, Akihiro Nishie, Yoshiki Asayama, Yasuhiro Ushijima, Yukihisa Takayama, Daisuke Okamoto, Nobuhiro Fujita, Toru Ikegami, Tomoharu Yoshizumi, Kousei Ishigami

    Transplantation proceedings   53 ( 5 )   1653 - 1658   2021.6

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    BACKGROUND: The hemodynamics of congestion areas in the right lobe graft after living donor liver transplantation (LDLT) remains unclear. The aim of this study was to elucidate the hemodynamics of congestion areas in the right lobe graft after LDLT using computed tomography (CT) perfusion imaging and the dual-input maximum slope method. METHODS: Sixteen recipients underwent CT perfusion of the liver and portal phase abdominal to pelvic CT 1week after LDLT using a right lobe graft. The attenuation of segments V and VIII on the portal venous phase abdominal to the pelvic CT scan was classified into 3 categories: hyperattenuation, iso-attenuation, and hypoattenuation. Mean arterial blood flow (AF, mL/min/100 mL tissue), portal blood flow (PF, mL/min/100 mL tissue), and perfusion index (&#37;) [PI = AF/(AF + PF) × 100] were compared between the hyperattenuation group and iso-attenuation group. The independent t test was used for these statistical analyses. RESULTS: On the portal phase abdominal scan, 15 segments, 16 segments, and 1 segment showed hyperattenuation, iso-attenuation, and hypoattenuation, respectively. The mean AF and PI of the hyperattenuation group (44.4 ± 24.4, 30.2 ± 13.5) were significantly higher than those of the iso-attenuation group (28.0 ± 7.8, 19.9 ± 6.2) (P < .05, P < .05). CONCLUSIONS: The congested liver segments showed high AF and high PI on CT perfusion imaging. This method enables the feasible quantification of the hemodynamics and the description of focal hemodynamic change in the graft after LDLT.

    DOI: 10.1016/j.transproceed.2021.02.024

  • Spectrum of Pulmonary Fibrosis from Interstitial Lung Abnormality to Usual Interstitial Pneumonia: Importance of Identification and Quantification of Traction Bronchiectasis in Patient Management. International journal

    Takuya Hino, Kyung Soo Lee, Joungho Han, Akinori Hata, Kousei Ishigami, Hiroto Hatabu

    Korean journal of radiology   22 ( 5 )   811 - 828   2021.5

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    Following the introduction of a novel pathological concept of usual interstitial pneumonia (UIP) by Liebow and Carrington in 1969, diffuse interstitial pneumonia has evolved into UIP, nonspecific interstitial pneumonia (NSIP), and interstitial lung abnormality (ILA); the histopathological and CT findings of these conditions reflect the required multidisciplinary team approach, involving pulmonologists, radiologists, and pathologists, for their diagnosis and management. Concomitantly, traction bronchiectasis and bronchiolectasis have been recognized as the most persistent and important indices of the severity and prognosis of fibrotic lung diseases. The traction bronchiectasis index (TBI) can stratify the prognoses of patients with ILAs. In this review, the evolutionary concepts of UIP, NSIP, and ILAs are summarized in tables and figures, with a demonstration of the correlation between CT findings and pathologic evaluation. The CT-based UIP score is being proposed to facilitate a better understanding of the spectrum of pulmonary fibrosis, from ILAs to UIP, with emphasis on traction bronchiectasis/bronchiolectasis.

    DOI: 10.3348/kjr.2020.1132

  • 123I metaiodobenzylguanidine (MIBG) uptake predicts early relapse of neuroblastoma using semi-quantitative SPECT/CT analysis.

    Yoshiyuki Kitamura, Shingo Baba, Takuro Isoda, Yasuhiro Maruoka, Masayuki Sasaki, Takeshi Kamitani, Yuhki Koga, Naonori Kawakubo, Toshiharu Matsuura, Kousei Ishigami

    Annals of nuclear medicine   35 ( 5 )   549 - 556   2021.5

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    OBJECTIVE: 123I metaiodobenzylguanidine (MIBG) scintigraphy is a useful tool for the diagnosis of neuroblastoma (NB). MIBG uptake is correlated with norepinephrine transporter expression; hence, it is expected that high-MIBG tumors would be more highly differentiated and have a better prognosis than those with lower expression. We have introduced a method of assessing MIBG accumulation semi-quantitatively using SPECT/CT fusion images. The purpose of this study was to evaluate the relationship of 123I MIBG uptake measured by semi-quantitative values of SPECT/CT and early relapse of NB. METHODS: We studied the cases of 11 patients (5 males and 6 females, age 5-65 months, median age 20 months) with histopathologically proven NB between April 2010 and March 2015. The early-relapse group was defined as patients who had relapsed within 3 years after the first 123I MIBG SPECT/CT exam. Other patients were classified as the delay-relapse group. Uptake of MIBG was evaluated using the count ratio of tumor and muscles. T/Mmax and T/Mmean were defined as follows: T/Mmax = max count of tumor/max count of muscle, T/Mmean = mean count of tumor/mean count of muscle. RESULTS: The average T/Mmean values of the early-relapse group and delay-relapse group were 2.65 ± 0.58 and 7.66 ± 2.68, respectively. The T/Mmean values of the early-relapse group were significantly lower than those of delay-relapse group (p < 0.05). The average T/Mmax of the early-relapse group and delay-relapse group were 8.86 ± 3.22 and 16.20 ± 1.97, respectively. There was no significant difference in T/Mmax values between the two groups. CONCLUSIONS: Low 123I MIBG uptake using semi-quantitative SPECT/CT analysis was correlated with early relapse of NB.

    DOI: 10.1007/s12149-021-01595-7

  • Spectrum of Pulmonary Fibrosis from Interstitial Lung Abnormality to Usual Interstitial Pneumonia: Importance of Identification and Quantification of Traction Bronchiectasis in Patient Management. International journal

    Takuya Hino, Kyung Soo Lee, Joungho Han, Akinori Hata, Kousei Ishigami, Hiroto Hatabu

    Korean journal of radiology   22 ( 5 )   811 - 828   2021.5

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    Following the introduction of a novel pathological concept of usual interstitial pneumonia (UIP) by Liebow and Carrington in 1969, diffuse interstitial pneumonia has evolved into UIP, nonspecific interstitial pneumonia (NSIP), and interstitial lung abnormality (ILA); the histopathological and CT findings of these conditions reflect the required multidisciplinary team approach, involving pulmonologists, radiologists, and pathologists, for their diagnosis and management. Concomitantly, traction bronchiectasis and bronchiolectasis have been recognized as the most persistent and important indices of the severity and prognosis of fibrotic lung diseases. The traction bronchiectasis index (TBI) can stratify the prognoses of patients with ILAs. In this review, the evolutionary concepts of UIP, NSIP, and ILAs are summarized in tables and figures, with a demonstration of the correlation between CT findings and pathologic evaluation. The CT-based UIP score is being proposed to facilitate a better understanding of the spectrum of pulmonary fibrosis, from ILAs to UIP, with emphasis on traction bronchiectasis/bronchiolectasis.

    DOI: 10.3348/kjr.2020.1132

  • Surgically resected hepatic mass caused by fascioliasis.

    Huanlin Wang, Shinji Itoh, Yuji Matsumoto, Akihiro Nishie, Takeshi Kurihara, Tomonari Shimagaki, Yoshihiro Nagao, Takeo Toshima, Noboru Harada, Kenichi Kohashi, Yoshinao Oda, Kousei Ishigami, Haruhiko Maruyama, Tomoharu Yoshizumi, Masaki Mori

    Clinical journal of gastroenterology   14 ( 2 )   662 - 667   2021.4

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    Fascioliasis is a parasitic infestation caused by the digenetic trematodes Fasciola hepatica and F. gigantica. It is not commonly seen in developed countries, so diagnosis there is always difficult as a result of confusion with other hepatic or biliary disorders. A 56-year-old man presented at our hospital with a hepatic mass that had been inadvertently discovered by ultrasonography. Abdominal computed tomography revealed a multi-cystic lesion distributed along the branch of the right bile duct. Endoscopic retrograde cholangiopancreatography showed serrated changes ranging from the upper level of the common bile duct to the right hepatic bile duct. Eosinophilia was not observed and tumor marker levels were within normal ranges. Following right lobectomy combined with bile duct reconstruction, a histological examination revealed cholangitis with inflammatory cell infiltration accompanied by parasite egg-like structures and Charcot-Leyden crystals. An additional serologic test was positive for F. hepatica antibodies. A diagnosis of fascioliasis was thus confirmed by histopathology and serology. Fascioliasis should be suspected if imaging findings such as multiple small hypodense lesions in the liver are observed, and serologic tests can be useful for differential diagnosis.

    DOI: 10.1007/s12328-021-01339-0

  • Differentiating Liver Hemangioma from Metastatic Tumor Using T2-enhanced Spin-echo Imaging with a Time-reversed Gradient-echo Sequence in the Hepatobiliary Phase of Gadoxetic Acid-enhanced MR Imaging.

    Yukihisa Takayama, Akihiro Nishie, Daisuke Okamoto, Nobuhiro Fujita, Yoshiki Asayama, Yasuhiro Ushijima, Tomoharu Yoshizumi, Masami Yoneyama, Kousei Ishigami

    Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine   21 ( 3 )   445 - 457   2021.4

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    PURPOSE: To evaluate the utility of T2-enhanced spin-echo imaging using the time-reversed gradient echo sequence (T2FFE imaging) in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI (Gd-EOB-MRI) for differentiating hemangiomas from metastatic tumors. METHODS: A total of 61 patients with 133 liver lesions, including 37 hemangiomas and 96 metastatic tumors, were scanned by Gd-EOB-MRI. Four data sets were independently analyzed by two readers: (1) 3D fat-suppressed T2-weighted imaging (FS-T2WI) alone; (2) the combination of 3D FS-T2WI and T2FFE imaging in the HBP of Gd-EOB-MRI; (3) the combination of 3D FS-T2WI, diffusion-weighted imaging (DWI) with the b-value of 1000 s/mm2 and the apparent diffusion coefficient (ADC); and (4) a dynamic study of Gd-EOB-MRI. After classifying the lesion sizes as ≤ 10 mm or > 10 mm, we conducted a receiver-operating characteristic analysis to compare diagnostic accuracies among the four data sets for differentiating hemangiomas from metastatic tumors. RESULTS: The areas under the curves (AUCs) of the four data sets of two readers were: (1) ≤ 10 mm (0.85 and 0.91) and > 10 mm (0.88 and 0.97), (2) ≤ 10 mm (0.94 and 0.94) and > 10 mm (0.96 and 0.95), (3) ≤ 10 mm (0.90 and 0.87) and > 10 mm (0.89 and 0.95), and (4) ≤ 10 mm (0.62 and 0.67) and > 10 mm (0.76 and 0.71), respectively. Data sets (2) and (3) showed no significant differences in AUCs, but both showed significantly higher AUCs compared to that of (4) regardless of the lesion size (P < 0.05). CONCLUSION: The combination of 3D FS-T2WI and T2FFE imaging in the HBP of Gd-EOB-MRI achieved an accuracy equivalent to that of the combination of 3D FS-T2WI, DWI, and ADC and might be helpful in differentiating hemangiomas from metastatic tumors.

    DOI: 10.2463/mrms.mp.2020-0151

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

    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   22 ( 4 )   634 - 651   2021.4

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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.

    DOI: 10.3348/kjr.2020.1136

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

    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   22 ( 4 )   634 - 651   2021.4

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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.

    DOI: 10.3348/kjr.2020.1136

  • Right Ventricular Extracellular Volume with Dual-Layer Spectral Detector CT: Value in Chronic Thromboembolic Pulmonary Hypertension. International journal

    Yuzo Yamasaki, Kohtaro Abe, Takeshi Kamitani, Koji Sagiyama, Tomoyuki Hida, Kazuya Hosokawa, Yuko Matsuura, Kazuhito Hioki, Michinobu Nagao, Hidetake Yabuuchi, Kousei Ishigami

    Radiology   298 ( 3 )   589 - 596   2021.3

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    Background Right ventricular (RV) extracellular volumes (ECVs), as a surrogate for histologic fibrosis, have not been sufficiently investigated. Purpose To evaluate and compare RV and left ventricular (LV) ECVs obtained with dual-layer spectral detector CT (DLCT) in chronic thromboembolic pulmonary hypertension (CTEPH) and investigate the clinical importance of RV ECV. Materials and Methods Retrospective analysis was performed on data from 31 patients with CTEPH (17 were not treated with pulmonary endarterectomy [PEA] or balloon pulmonary angioplasty [BPA] and 14 were) and eight control subjects who underwent myocardial delayed enhancement (MDE) DLCT from January 2019 to June 2020. The ECVs in the RV and LV walls were calculated by using iodine density as derived from spectral data pertaining to MDE. Statistical analyses were performed with one-way repeated analysis of variance with the Tukey post hoc test or the Kruskal-Wallis test with the Steel-Dwass test and linear regression analysis. Results The PEA- and BPA-naive group showed significantly higher ECVs than the PEA- or BPA-treated group and control group in the septum (28.2&#37; ± 2.9 vs 24.3&#37; ± 3.6, P = .005), anterior right ventricular insertion point (RVIP) (32.9&#37; ± 4.6 vs 25.3&#37; ± 3.6, P < .001), posterior RVIP (35.2&#37; ± 5.2 vs 27.3&#37; ± 4.2, P < .001), mean RVIP (34.0&#37; ± 4.2 vs 26.3&#37; ± 3.4, P < .001), RV free wall (29.5&#37; ± 3.3 vs 25.9&#37; ± 4.1, P = .036), and mean RV wall (29.1&#37; ± 3.0 vs 26.1&#37; ± 3.1, P = .029). There were no significant differences between the PEA- or BPA-treated group and control subjects in these segments (septum, P = .93; anterior RVIP, P = .38; posterior RVIP, P = .52; mean RVIP, P = .36; RV free wall, P = .97; and mean RV, P = .33). There were significant correlations between ECV and mean pulmonary artery pressure (PAP) or brain natriuretic peptide (BNP) in the mean RVIP (mean PAP: R = 0.66, P < .001; BNP: R = 0.44, P = .014) and the mean RV (mean PAP: R = 0.49, P = .005; BNP: R = 0.44, P = .013). Conclusion Right ventricular and right ventricular insertion point extracellular volumes could be noninvasive surrogate markers of disease severity and reverse tissue remodeling in chronic thromboembolic pulmonary hypertension. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Sandfort and Bluemke in this issue.

    DOI: 10.1148/radiol.2020203719

  • Cryoablation for Secondary Renal Cell Carcinoma After Surgical Nephrectomy. International journal

    Yasuhiro Ushijima, Yoshiki Asayama, Akihiro Nishie, Yukihisa Takayama, Yuichiro Kubo, Keisuke Ishimatsu, Kousei Ishigami

    Cardiovascular and interventional radiology   44 ( 3 )   414 - 420   2021.3

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    PURPOSE: To retrospectively evaluate the clinical outcomes of cryoablation for secondary renal cell carcinoma for patients with a history of nephrectomy for initial renal cell carcinoma. MATERIALS AND METHODS: Thirty patients with 40 renal tumors who had undergone a nephrectomy for initial renal cell carcinoma and cryoablation for renal cell carcinoma as a secondary treatment during the period from April 2014 to December 2018 at a single center institution were enrolled. The patients' overall survival, local control, relapse-free survival, change of renal function, and complications were evaluated. The clinical factors of relapse-free survival were also evaluated. RESULTS: The 5 year overall survival rate was 94.5&#37;, the 5 year local control rate was 89.3&#37;, and the 5 year relapse-free survival rate (RFSR) was 56.3&#37;. There was an average reduction in renal function of 8.5&#37; after 1 year, and > grade 3 complications occurred in only one case. The RFSR in the patients whose initial stage was T3 was 0&#37;, significantly lower than the 70.4&#37; RFSR in the patients whose initial stage was T1 or T2. CONCLUSION: Cryoablation for secondary renal cell carcinoma after nephrectomy was safe and provided good local control with preserved renal function. However, the indications for cryoablation should be carefully considered for patients with T3-stage initial renal cell carcinoma, because of the high risk of relapse. LEVEL OF EVIDENCE: III.

    DOI: 10.1007/s00270-020-02709-w

  • Noninvasive assessment of liver fibrosis by dual-layer spectral detector CT. International journal

    Koichiro Morita, Akihiro Nishie, Yasuhiro Ushijima, Yukihisa Takayama, Nobuhiro Fujita, Yuichiro Kubo, Keisuke Ishimatsu, Tomoharu Yoshizumi, Junki Maehara, Kousei Ishigami

    European journal of radiology   136   109575 - 109575   2021.3

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    PURPOSE: To elucidate the diagnostic ability of liver fibrosis using (1) liver parenchymal iodine density on equilibrium computed tomographic imaging and (2) extracellular volume (ECV) measured by dual-layer spectral detector CT. METHODS: From April 2018 to June 2019, 68 patients [mean age, 62 years; 39 males, 29 females] underwent dynamic contrast-enhanced CT by a dual-layer spectral detector CT system before liver transplantation or liver resection. The iodine densities of liver parenchyma (I liver) and aorta (I aorta) were independently measured by two radiologists at the equilibrium phase. The iodine-density ratio (I-ratio) (I liver/ I aorta) and the CT-ECV were calculated. Spearman's rank correlation coefficient was used to analyze the relationship between the I-ratio or the CT-ECV and the fibrosis stage. A receiver operating characteristic (ROC) curve analysis was performed to determine the accuracy of the I-ratio and the CT-ECV for discriminating fibrosis stages. RESULTS: For both readers, the I-ratio and the CT-ECV increased significantly as the fibrosis stage advanced (I-ratio: rho = 0.380 and 0.443, p < 0.01; CT-ECV: rho = 0.423 and 0.469, p < 0.01). The CT-ECV showed better diagnostic accuracy for staging fibrosis, and the area under the ROC curve values for discriminating F4 stage were 0.884 and 0.925. The two readers' cutoff values of the CT-ECV for diagnosing fibrosis as F4 were 26.2 % and 29.3 %, with 95.0 % and 90.0 % sensitivity and 72.9 % and 85.4 % specificity, respectively. CONCLUSION: The liver parenchymal iodine density on the equilibrium phase and the CT-ECV can be useful for predicting a high stage of liver fibrosis.

    DOI: 10.1016/j.ejrad.2021.109575

  • Obesity is a risk factor for intrahepatic cholangiocarcinoma progression associated with alterations of metabolic activity and immune status. International journal

    Kyohei Yugawa, Shinji Itoh, Norifumi Iseda, Takeshi Kurihara, Yoshiyuki Kitamura, Takeo Toshima, Noboru Harada, Kenichi Kohashi, Shingo Baba, Kousei Ishigami, Yoshinao Oda, Tomoharu Yoshizumi, Masaki Mori

    Scientific reports   11 ( 1 )   5845 - 5845   2021.3

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    Body mass index (BMI) is well known to be associated with poor prognosis in several cancers. The relationship between BMI and the long-term outcomes of patients with intrahepatic cholangiocarcinoma (ICC) is incompletely understood. This study investigated the relationships of BMI with clinicopathological characteristics and patient outcomes, focusing on metabolic activity and immune status. The relationship between BMI and the maximum standardized uptake value (SUVmax) on fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) was analyzed. In addition, immunohistochemistry was performed for programmed cell death-ligand 1 (PD-L1), cluster of differentiation 8 (CD8), and forkhead box protein P3 (Foxp3). Seventy-four patients with ICC were classified into normal weight (BMI < 25.0 kg/m2, n = 48) and obesity groups (BMI ≥ 25.0 kg/m2, n = 26), respectively. Serum carbohydrate antigen 19-9 levels were higher in the obesity group than in the normal weight group. Tumor size and the intrahepatic metastasis rate were significantly larger in the obesity group. Patients in the obesity group had significantly worse prognoses than those in the normal weight group. Moreover, BMI displayed a positive correlation with SUVmax on 18F-FDG PET/CT (n = 46, r = 0.5152). Patients with high 18F-FDG uptake had a significantly higher rate of PD-L1 expression, lower CD8 + tumor-infiltrating lymphocyte (TIL) counts, and higher Foxp3 + TIL counts. The elevated BMI might predict the outcomes of patients with ICC. Obesity might be associated with ICC progression, possibly through alterations in metabolic activity and the immune status.

    DOI: 10.1038/s41598-021-85186-6

  • Noninvasive assessment of liver fibrosis by dual-layer spectral detector CT. International journal

    Koichiro Morita, Akihiro Nishie, Yasuhiro Ushijima, Yukihisa Takayama, Nobuhiro Fujita, Yuichiro Kubo, Keisuke Ishimatsu, Tomoharu Yoshizumi, Junki Maehara, Kousei Ishigami

    European journal of radiology   136   109575 - 109575   2021.3

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    PURPOSE: To elucidate the diagnostic ability of liver fibrosis using (1) liver parenchymal iodine density on equilibrium computed tomographic imaging and (2) extracellular volume (ECV) measured by dual-layer spectral detector CT. METHODS: From April 2018 to June 2019, 68 patients [mean age, 62 years; 39 males, 29 females] underwent dynamic contrast-enhanced CT by a dual-layer spectral detector CT system before liver transplantation or liver resection. The iodine densities of liver parenchyma (I liver) and aorta (I aorta) were independently measured by two radiologists at the equilibrium phase. The iodine-density ratio (I-ratio) (I liver/ I aorta) and the CT-ECV were calculated. Spearman's rank correlation coefficient was used to analyze the relationship between the I-ratio or the CT-ECV and the fibrosis stage. A receiver operating characteristic (ROC) curve analysis was performed to determine the accuracy of the I-ratio and the CT-ECV for discriminating fibrosis stages. RESULTS: For both readers, the I-ratio and the CT-ECV increased significantly as the fibrosis stage advanced (I-ratio: rho = 0.380 and 0.443, p < 0.01; CT-ECV: rho = 0.423 and 0.469, p < 0.01). The CT-ECV showed better diagnostic accuracy for staging fibrosis, and the area under the ROC curve values for discriminating F4 stage were 0.884 and 0.925. The two readers' cutoff values of the CT-ECV for diagnosing fibrosis as F4 were 26.2 &#37; and 29.3 &#37;, with 95.0 &#37; and 90.0 &#37; sensitivity and 72.9 &#37; and 85.4 &#37; specificity, respectively. CONCLUSION: The liver parenchymal iodine density on the equilibrium phase and the CT-ECV can be useful for predicting a high stage of liver fibrosis.

    DOI: 10.1016/j.ejrad.2021.109575

  • Obesity is a risk factor for intrahepatic cholangiocarcinoma progression associated with alterations of metabolic activity and immune status. International journal

    Kyohei Yugawa, Shinji Itoh, Norifumi Iseda, Takeshi Kurihara, Yoshiyuki Kitamura, Takeo Toshima, Noboru Harada, Kenichi Kohashi, Shingo Baba, Kousei Ishigami, Yoshinao Oda, Tomoharu Yoshizumi, Masaki Mori

    Scientific reports   11 ( 1 )   5845 - 5845   2021.3

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    Body mass index (BMI) is well known to be associated with poor prognosis in several cancers. The relationship between BMI and the long-term outcomes of patients with intrahepatic cholangiocarcinoma (ICC) is incompletely understood. This study investigated the relationships of BMI with clinicopathological characteristics and patient outcomes, focusing on metabolic activity and immune status. The relationship between BMI and the maximum standardized uptake value (SUVmax) on fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) was analyzed. In addition, immunohistochemistry was performed for programmed cell death-ligand 1 (PD-L1), cluster of differentiation 8 (CD8), and forkhead box protein P3 (Foxp3). Seventy-four patients with ICC were classified into normal weight (BMI < 25.0 kg/m2, n = 48) and obesity groups (BMI ≥ 25.0 kg/m2, n = 26), respectively. Serum carbohydrate antigen 19-9 levels were higher in the obesity group than in the normal weight group. Tumor size and the intrahepatic metastasis rate were significantly larger in the obesity group. Patients in the obesity group had significantly worse prognoses than those in the normal weight group. Moreover, BMI displayed a positive correlation with SUVmax on 18F-FDG PET/CT (n = 46, r = 0.5152). Patients with high 18F-FDG uptake had a significantly higher rate of PD-L1 expression, lower CD8 + tumor-infiltrating lymphocyte (TIL) counts, and higher Foxp3 + TIL counts. The elevated BMI might predict the outcomes of patients with ICC. Obesity might be associated with ICC progression, possibly through alterations in metabolic activity and the immune status.

    DOI: 10.1038/s41598-021-85186-6

  • A novel fast kilovoltage switching dual-energy CT with deep learning: Accuracy of CT number on virtual monochromatic imaging and iodine quantification. International journal

    Tsukasa Kojima, Takashi Shirasaka, Masatoshi Kondo, Toyoyuki Kato, Akihiro Nishie, Kousei Ishigami, Hidetake Yabuuchi

    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)   81   253 - 261   2021.1

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    PURPOSE: A novel fast kilovoltage switching dual-energy CT with deep learning [Deep learning based-spectral CT (DL-Spectral CT)], which generates a complete sinogram for each kilovolt using deep learning views that complement the measured views at each energy, was commercialized in 2020. The purpose of this study was to evaluate the accuracy of CT numbers in virtual monochromatic images (VMIs) and iodine quantifications at various radiation doses using DL-Spectral CT. MATERIALS AND METHODS: Two multi-energy phantoms (large and small) using several rods representing different materials (iodine, calcium, blood, and adipose) were scanned by DL-Spectral CT at varying radiation doses. Images were reconstructed using three reconstruction parameters (body, lung, bone). The absolute percentage errors (APEs) for CT numbers on VMIs at 50, 70, and 100 keV and iodine quantification were compared among different radiation dose protocols. RESULTS: The APEs of the CT numbers on VMIs were <15&#37; in both the large and small phantoms, except at the minimum dose in the large phantom. There were no significant differences among radiation dose protocols in computed tomography dose index volumes of 12.3 mGy or larger. The accuracy of iodine quantification provided by the body parameter was significantly better than those obtained with the lung and bone parameters. Increasing the radiation dose did not always improve the accuracy of iodine quantification, regardless of the reconstruction parameter and phantom size. CONCLUSION: The accuracy of iodine quantification and CT numbers on VMIs in DL-Spectral CT was not affected by the radiation dose, except for an extremely low radiation dose for body size.

    DOI: 10.1016/j.ejmp.2020.12.018

  • The prognosis and the impact of radiotherapy in clinically regional lymph node-positive prostate cancer: Which patients are candidates for local therapy with radiation? International journal

    Kosuke Ieiri, Masaki Shiota, Eiji Kashiwagi, Ario Takeuchi, Ryosuke Takahashi, Junichi Inokuchi, Hidenori Iwai, Ken-Ichiro Shiga, Akira Yokomizo, Tadamasa Yoshitake, Yoshiyuki Shioyama, Kousei Ishigami, Hiromi Terashima, Masatoshi Eto

    Urologic oncology   38 ( 12 )   931.e1-931.e7   2020.12

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    BACKGROUND: This study aimed to identify the prognostic and predictive factors of local radiotherapy in clinically regional lymph node-positive prostate cancer. PATIENTS AND METHODS: This study includes patients who were newly diagnosed with regional lymph node-positive prostate cancer between 2008 and 2017. We investigated the prognostic value of clinicopathological parameters for progression-free survival (PFS) and overall survival (OS) as well as the differential prognostic impact of radiotherapy by subgroup analysis. RESULTS: Among the 93 men enrolled as patients, 48 (51.6 &#37;) were treated with radiotherapy. The biopsy positive core rate and biopsy Gleason score were associated with PFS, and the number of lymph node metastases was associated with both PFS and OS. Patients who underwent radiotherapy showed better PFS and OS. High-risk features (at least 2 criteria among ≥75&#37; biopsy positive core rate, Gleason score ≥9, and ≥2 positive lymph nodes) were especially associated with improved outcomes after undergoing radiotherapy. CONCLUSION: We identified prognostic factors for clinically regional lymph node-positive prostate cancer and showed the benefits of local radiation therapy. Patients with high-risk features may be especially suitable candidates for radiotherapy.

    DOI: 10.1016/j.urolonc.2020.08.018

  • Quantitative evaluation of liver function and pathology with hepatocyte fraction on Gadoxetic acid-enhanced MR imaging. International journal

    Nobuhiro Fujita, Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Yasuhiro Ushijima, Daisuke Kakihara, Yukihisa Takayama, Tomoharu Yoshizumi, Tomoyuki Hida, Yoshinao Oda, Tomoyuki Okuaki, Hiroshi Honda

    Magnetic resonance imaging   73   125 - 129   2020.11

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    DOI: 10.1016/j.mri.2020.08.018

  • Congenital biliary dilatation in the era of laparoscopic surgery, focusing on the high incidence of anatomical variations of the right hepatic artery.

    Yasuhisa Mori, Kohei Nakata, Mohammed Y F Aly, Noboru Ideno, Naoki Ikenaga, Yasuhiro Okabe, Kousei Ishigami, Yoshinao Oda, Masafumi Nakamura

    Journal of hepato-biliary-pancreatic sciences   27 ( 11 )   870 - 876   2020.11

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    BACKGROUND: The present study aimed to evaluate anatomical variations of the right hepatic artery (RHA) in patients with congenital biliary dilatation (CBD) and the appropriate approach in laparoscopic surgery for CBD. METHODS: The medical records of 36 patients who underwent laparoscopic or open surgery for CBD from 1996 to 2018 were retrospectively reviewed. Radiological evaluation of the origin and course of the RHA in these 36 patients were compared with 195 control patients without CBD. RESULTS: The incidence of the RHA crossing anterior to the common hepatic duct (CHD) was significantly higher in patients with CBD than in those without CBD (33&#37; versus 10&#37;, P = .0001). There was no intraoperative injury of the RHA, irrespective of the course of the RHA. The CHD was divided at the caudal side of the RHA in 11 of 12 patients (92&#37;) with the anterior type of RHA, and in 13 of 24 patients (54&#37;) with the posterior type of RHA (P = .03). CONCLUSIONS: Patients with CBD had a higher incidence of the RHA crossing anterior to the CHD than patients without CBD. Preservation of the RHA in each situation is necessary during surgery for CBD in the era of laparoscopic surgery.

    DOI: 10.1002/jhbp.819

  • Computed tomography surveillance helps tracking COVID-19 outbreak. Reviewed

    Akihiro Machitori, Tomoyuki Noguchi, Yusuke Kawata, Nobuhiko Horioka, Akihiro Nishie, Daisuke Kakihara, Kousei Ishigami, Shigeki Aoki, Yutaka Imai

    Japanese journal of radiology   2020.8

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    PURPOSE: To reveal that a computed tomography surveillance program (CT-surveillance) could demonstrate the epidemiologic features of COVID-19 infection and simultaneously investigate the type and frequency of CT findings using clinical CT data. MATERIALS AND METHODS: We targeted individuals with possible CT findings of viral pneumonia. Using an online questionnaire, we asked Japanese board-certified radiologists to register their patients' information including patient age and sex, the CT examination date, the results of PCR test for COVID-19 infection, CT findings, and the postal code of the medical institution that performed the CT. We compared the diurnal patient number and the cumulative regional distribution map of registrations in CT-surveillance to those of the PCR-positive patient surveillance (PCR-surveillance). RESULTS: A total of 637 patients was registered from January 1 to April 17, 2020 for CT-surveillance. Their PCR test results were positive (n = 62.5-398&#37;), negative (n = 8.9-57&#37;), unknown (n = 26.2-167&#37;), and other disease (n = 2.4-15&#37;). An age peak at 60-69 years and male dominance were observed in CT-surveillance. The most common CT finding was bilaterally distributed ground-glass opacities. The diurnal number and the cumulative regional distribution map by CT-surveillance showed tendencies that were similar to those revealed by PCR-surveillance. CONCLUSION: Using clinical CT data, CT-surveillance program delineated the epidemiologic features of COVID-19 infection.

    DOI: 10.1007/s11604-020-01026-z

  • Risk factors of recurrence after postoperative electron beam radiation therapy for keloid: Comparison of long-term local control rate

    Hitoshi Maemoto, Shiro Iraha, Ken Arashiro, Kousei Ishigami, Fumikiyo Ganaha, Sadayuki Murayama

    Reports of Practical Oncology & Radiotherapy   25 ( 4 )   606 - 611   2020.7

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    DOI: 10.1016/j.rpor.2020.05.001

  • Risk factors of recurrence after postoperative electron beam radiation therapy for keloid: Comparison of long-term local control rate

    Hitoshi Maemoto, Shiro Iraha, Ken Arashiro, Kousei Ishigami, Fumikiyo Ganaha, Sadayuki Murayama

    Reports of Practical Oncology & Radiotherapy   25 ( 4 )   606 - 611   2020.7

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    DOI: 10.1016/j.rpor.2020.05.001

  • Pulmonary ventilation-perfusion mismatch demonstrated by dynamic chest radiography in giant cell arteritis. Reviewed International journal

    Yuzo Yamasaki, Kazuya Hosokawa, Hiroyuki Tsutsui, Kousei Ishigami

    European heart journal   42 ( 2 )   208 - 209   2020.6

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    DOI: 10.1093/eurheartj/ehaa443

  • Improved visualization of a fine intrahepatic biliary duct on drip infusion cholangiography-computed tomography: Impact of knowledge-based iterative model reconstruction. Reviewed International journal

    Seiichiro Takao, Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Yasuhiro Ushijima, Daisuke Kakihara, Tomohiro Nakayama, Nobuhiro Fujita, Koichiro Morita, Keisuke Ishimatsu, Tomoharu Yoshizumi, Toru Ikegami, Masatoshi Kondo, Hiroshi Honda

    Hepatology research : the official journal of the Japan Society of Hepatology   50 ( 5 )   629 - 634   2020.5

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    AIM: The purpose of this study was to investigate the visualization of fine biliary ducts with knowledge-based iterative model reconstruction (IMR) in low-dose drip infusion computed tomography (CT) cholangiography (DIC-CT) as compared with filtered back projection (FBP) and hybrid iterative reconstruction (iDose4 ). METHODS: A total of 38 patients underwent DIC-CT for living donor liver transplantation. CT was performed approximately 20 min after the end of the infusion of meglumine iotroxate (100 mL). Images were reconstructed using FBP, iDose4 , and IMR, and 1-mm slice images at fixed window level and width were prepared for assessment. Two reviewers independently evaluated the quality of visualization of the fine biliary ducts of the caudate lobe (B1) using a 5-point scale. The visualization scores of three reconstructed images were compared using the Kruskal-Wallis test and Mann-Whitney U-test. RESULTS: For reviewer 1, the visualization score of IMR was significantly higher than that of FBP (P = 0.012), and tended to be higher than that of iDose4 (P = 0.078). For reviewer 2, the visualization score of IMR was significantly higher than those of both FBP and iDose4 (P < 0.01). CONCLUSIONS: IMR showed better visualization of B1 on DIC-CT than FBP or iDose4 . DIC-CT reconstructed with IMR may be useful to the anatomical grasp of biliary tracts in cases of hepatectomy.

    DOI: 10.1111/hepr.13477

  • Safety and Efficacy of Embolization Using N-Butyl Cyanoacrylate via a Percutaneous Direct Approach for Endoleaks after Abdominal/Thoracic Endovascular Aortic Repair.

    Yasuhiro Ushijima, Yoshiki Asayama, Akihiro Nishie, Kousei Ishigami, Yukihisa Takayama, Daisuke Okamoto, Nobuhiro Fujita, Koichiro Morita, Hiroshi Honda

    Interventional radiology (Higashimatsuyama-shi (Japan)   5 ( 1 )   1 - 9   2020.2

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    PURPOSE: To elucidate the safety and efficacy of embolization using N-butyl cyanoacrylate (NBCA) for endoleaks after abdominal/thoracic endovascular aortic repair (EVAR/TEVAR) via a direct percutaneous approach versus a transarterial approach. MATERIALS AND METHODS: The retrospective design of the study was approved by the institutional ethics committee, and the requirement for informed written consent was waived. Sixteen patients underwent embolization for endoleaks after EVAR/TEVAR, which was diagnosed as type II, from March 2010 to December 2013 at our institution. The number of embolization sessions was 21. A direct percutaneous approach was used in 10 sessions, and a transarterial approach was used in 11 sessions. There were 11 and 15 embolic sites for the two approaches, respectively. The procedure time, amount of contrast media used, therapeutic effect, and complications were evaluated. RESULTS: The mean procedure time (per embolic site) was 100 min (53-170) in the direct percutaneous approach, which was significantly shorter than the 191 min (76-275) in the transarterial approach. The mean amount of contrast media used during the procedure (per embolic site) was 12.8 ml (3-25) by the direct percutaneous approach, which was significantly lesser than the 71.8 ml (30-180) in the transarterial approach. Local control of the embolic site and interval increase in the size of aneurysm after embolization were not significantly different between the two approaches. In one case each, mesenteric hematoma and migration of the embolic agent occurred with a direct percutaneous approach, and a small arterial injury occurred with the transarterial approach; aneurysmal rupture/perianeurysmal hematoma and neurological dysfunction were not observed. CONCLUSION: A direct percutaneous approach is a feasible procedure for embolization of endoleaks after EVAR/TEVAR.

    DOI: 10.22575/interventionalradiology.2018-0018

  • DIC-CTにおける胆管描出能 iterative model reconstruction(IMR)の有用性

    高尾 誠一朗, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 柿原 大輔, 中山 智博, 藤田 展宏, 本田 浩, 吉住 朋晴

    Japanese Journal of Radiology   38 ( Suppl. )   92 - 92   2020.2

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  • Prediction of the Probability of Malignancy in Mucinous Cystic Neoplasm of the Pancreas With Ovarian-Type Stroma: A Nationwide Multicenter Study in Japan. Reviewed International journal

    Takao Ohtsuka, Masafumi Nakamura, Susumu Hijioka, Yasuhiro Shimizu, Michiaki Unno, Minoru Tanabe, Yuichi Nagakawa, Kyoichi Takaori, Seiko Hirono, Naoto Gotohda, Wataru Kimura, Kei Ito, Akio Katanuma, Tsuyoshi Sano, Takahiro Urata, Emiri Kita, Keiji Hanada, Minoru Tada, Takeshi Aoki, Masahiro Serikawa, Kojun Okamoto, Hiroyuki Isayama, Yoshitaka Gotoh, Kousei Ishigami, Hiroshi Yamaguchi, Kenji Yamao, Masanori Sugiyama, Kazuichi Okazaki

    Pancreas   49 ( 2 )   181 - 186   2020.2

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    OBJECTIVE: The aim of the study was to develop a formula for predicting the probability of malignancy of mucinous cystic neoplasm (MCN) of the pancreas with ovarian-type stroma. METHODS: A total of 364 patients were enrolled. A total score was calculated as the sum of the approximate integers of the odds ratios of the predictive factors identified by multivariate analysis. The relationship between the total score and pathological results was assessed. RESULTS: A total of 321 patients had benign MCN and 43 had malignant MCN. Five possible predictive factors were analyzed: 56 years or older, high serum carcinoembryonic antigen level, high carbohydrate antigen 19-9 level, tumor size of 51 mm or greater, and the presence of mural nodules. The total score was significantly higher in patients with malignant MCN (median, 24; range, 0-37) compared with benign MCN (median, 5; range, 0-33; P < 0.001). Receiver operating characteristic curve analysis demonstrated that the area under the curve was 0.86, and the sensitivity and specificity of the total score for discriminating malignant MCNs were 72&#37; and 83&#37;, respectively, using a cut-off value of 22. CONCLUSIONS: The current simple formula can predict the malignancy of MCN and may thus contribute to the adequate management of patients with MCN.

    DOI: 10.1097/MPA.0000000000001475

  • Increased and More Heterogeneous Gadoxetic Acid Uptake of the Liver Parenchyma after Hepatitis C Virus Eradication by Direct Antiviral Agent. Reviewed

    Nobuhiro Fujita, Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Tomohiro Nakayama, Yasuhiro Ushijima, Daisuke Kakihara, Yukihisa Takayama, Koichiro Morita, Keisuke Ishimatsu, Seiichiro Takao, Tomoharu Yoshizumi, Norihiro Furusyo, Hiroshi Honda

    Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine   19 ( 4 )   389 - 393   2020.2

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    We evaluated the changes of gadoxetic acid uptake of the liver parenchyma after hepatitis C virus (HCV) eradication by direct-antiviral agent (DAA) therapy. The increase rate of the liver-to-muscle signal intensity ratio, the skewness and the kurtosis were calculated in the hepatobiliary phase. After sustained virological response, gadoxetic acid uptake of the liver parenchyma increased, but became heterogeneous. Our study proved that HCV eradication by DAA therapy could significantly affect gadoxetic acid uptake.

    DOI: 10.2463/mrms.tn.2019-0183

  • Hyperintense Liver Masses at Hepatobiliary Phase Gadoxetic Acid-enhanced MRI: Imaging Appearances and Clinical Importance. Reviewed International journal

    Fujita N, Nishie A, Asayama Y, Ishigami K, Ushijima Y, Kakihara D, Nakayama T, Morita K, Ishimatsu K, Honda H

    Radiographics : a review publication of the Radiological Society of North America, Inc   40 ( 1 )   190037 - 94   2019.12

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    Hyperintense Liver Masses at Hepatobiliary Phase Gadoxetic Acid-enhanced MRI: Imaging Appearances and Clinical Importance.
    Gadoxetic acid, a hepatobiliary-specific contrast medium used for MRI, is becoming increasingly important in the detection and characterization of hepatic mass lesions. This medium is taken up by functioning hepatocytes, and the liver parenchyma is strongly enhanced in the hepatobiliary phase (HBP), during which hepatic mass lesions without functioning hepatocytes commonly show hypointensity. However, some hepatic mass lesions show hyperintensity in the HBP. Focal nodular hyperplasia (FNH) and FNH-like lesions show hyperintensity in the HBP owing to the uptake of gadoxetic acid by hyperplastic normal hepatocytes. The tumor cells of some types of hepatocellular adenoma (eg, β-catenin-activated type, inflammatory type) and hepatocellular carcinoma (eg, green hepatoma) can show uptake of gadoxetic acid. Retention of gadoxetic acid in the extracellular space can cause hyperintensity of fibrotic tumors or hemangiomas during the HBP owing to the extracellular contrast agent characteristics of gadoxetic acid. During the HBP, peritumoral retention is observed in some tumors, such as hepatocellular carcinomas, gastrointestinal stromal tumors, and neuroendocrine tumors. Gadoxetic acid is excreted into the bile; therefore, biliary tract enhancement can be observed in the cystic components of intraductal papillary neoplasms of the bile duct. Intratumoral bile ducts can be observed in malignant lymphomas. Knowledge of these specific mechanisms, which can cause hyperintensity during the HBP depending on the pathologic or molecular background, is important not only for precise imaging-based diagnoses but also for understanding the pathogenesis of hepatic mass lesions. ©RSNA, 2019 See discussion on this article by Lalwani.

    DOI: 10.1148/rg.2020190037

  • Imaging features of undifferentiated carcinoma of the pancreas. Reviewed International journal

    Ishigami K, Nishie A, Yamamoto T, Asayama Y, Ushijima Y, Kakihara D, Fujita N, Morita K, Ohtsuka T, Kawabe K, Mochidome N, Honda H

    Journal of medical imaging and radiation oncology   63 ( 5 )   580 - 588   2019.10

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    Imaging features of undifferentiated carcinoma of the pancreas.
    INTRODUCTION: The purpose of this retrospective study was to evaluate imaging features of undifferentiated carcinoma of the pancreas. METHODS: The study group included eight patients with surgically resected undifferentiated carcinoma of the pancreas. Multidetector-row computed tomography (MDCT, n = 8) and magnetic resonance imaging (MRI, n = 6) findings were retrospectively reviewed. RESULTS: On MDCT, all eight cases were hypovascular with upstream main pancreatic duct (MPD) dilatation, and only 1 showed exophytic growth. Five cases (62.5&#37;) showed necrosis/cystic change, and calcification was observed in two cases (25&#37;). Calcification reflected tumour osteoid components. On MRI, haemorrhage and hemosiderin were observed in 4 of 6 (66.7&#37;) cases. In addition, tumour thrombus in the splenic vein (n = 1) and intraductal tumour growth in the MPD (n = 2) were pathologically identified, although imaging studies only revealed 1 of these latter cases. CONCLUSION: Undifferentiated carcinoma of the pancreas may present as a tumour with haemorrhagic necrosis. Coexistence of calcification, intraductal tumour growth in the MPD and tumour thrombus may support the imaging diagnosis of this entity.

    DOI: 10.1111/1754-9485.12925

  • Superparamagnetic iron-oxide-enhanced diffusion-weighted magnetic resonance imaging for the diagnosis of intrapancreatic accessory spleen. Reviewed International journal

    Ishigami K, Nishie A, Nakayama T, Asayama Y, Kakihara D, Fujita N, Ushijima Y, Okamoto D, Ohtsuka T, Mori Y, Ito T, Mochidome N, Honda H

    Abdominal radiology (New York)   44 ( 10 )   3325 - 3335   2019.10

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    Superparamagnetic iron-oxide-enhanced diffusion-weighted magnetic resonance imaging for the diagnosis of intrapancreatic accessory spleen.
    PURPOSE: To evaluate the diagnostic performance of superparamagnetic iron-oxide (SPIO)-enhanced diffusion-weighted image (DWI) for distinguishing an intrapancreatic accessory spleen from pancreatic tumors. MATERIALS AND METHODS: Twenty-six cases of intrapancreatic accessory spleen and nine cases of pancreatic tail tumors [neuroendocrine tumor (n = 8) and pancreatic adenocarcinoma (n = 1)] were analyzed. Two blind reviewers retrospectively reviewed the SPIO-enhanced magnetic resonance imaging (MRI) scans. The lesion visibility grades were compared and the diagnostic performance of SPIO-enhanced DWI was compared to those of SPIO-enhanced T2WI and T2*WI with the use of a receiver operating characteristic (ROC) analysis. RESULTS: The grade of lesion visibility was the highest on DWI [mean ± standard deviation (SD): 2.8 ± 0.3] followed by T2WI (2.3 ± 0.7, p < 0.001) and T2*WI (2.1 ± 0.7, p < 0.0001). Reviewers 1 and 2 correctly characterized the presence or absence of SPIO uptake in 34 of 35 cases (97.1&#37;) on DWI, 24 (68.6&#37;) and 25 (71.4&#37;) cases on T2WI, respectively, and 16 (45.7&#37;) and 17 (48.6&#37;) cases on T2*WI. The area under the ROC curve (AUC) of DWI was 0.974 and 0.989 for reviewers 1 and 2, respectively. For Reviewer 1, the AUC of DWI was significantly higher than that of T2*WI (0.756, p < 0.01), although it was not significantly different from that of T2WI (0.868, p = 0.0857). For Reviewer 2, the AUC of DWI was significantly higher than those of T2WI (0.846, p < 0.05) and T2*WI (0.803, p < 0.01). CONCLUSION: The diagnostic performance of SPIO-enhanced DWI was better than those of SPIO-enhanced T2*WI and T2WI for the diagnosis of intrapancreatic accessory spleen.

    DOI: 10.1007/s00261-019-02189-8

  • Adrenal collision tumour comprised of adrenocortical carcinoma and myelolipoma in a patient with congenital adrenal hyperplasia. Reviewed

    Pakalniskis MG, Ishigami K, Pakalniskis BL, Fujita N

    Journal of medical imaging and radiation oncology   2019.10

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    Adrenal collision tumour comprised of adrenocortical carcinoma and myelolipoma in a patient with congenital adrenal hyperplasia.

    DOI: 10.1111/1754-9485.12961

  • Intravoxel incoherent motion magnetic resonance imaging for assessment of chronic pancreatitis with special focus on its early stage. Reviewed International journal

    Fujita N, Nishie A, Asayama Y, Ishigami K, Fujimori N, Ito T, Honda H

    Acta radiologica (Stockholm, Sweden : 1987)   61 ( 5 )   284185119872687 - 585   2019.9

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    Intravoxel incoherent motion magnetic resonance imaging for assessment of chronic pancreatitis with special focus on its early stage.

    DOI: 10.1177/0284185119872687

  • Symptomatic jugular venous reflux with dilatation of the superior ophthalmic vein mimicking cavernous dural arteriovenous fistula. Reviewed

    Nakamata A, Yogi A, Harakuni T, Ishigami K, Murayama S

    Radiology case reports   14 ( 9 )   1167 - 1170   2019.9

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    Symptomatic jugular venous reflux with dilatation of the superior ophthalmic vein mimicking cavernous dural arteriovenous fistula.

    DOI: 10.1016/j.radcr.2019.06.027

  • Analyses of size and computed tomography densitometry parameters for prediction of keloid recurrence after postoperative electron beam radiation therapy. Reviewed

    Maemoto H, Ishigami K, Iraha S, Arashiro K, Kusada T, Ganaha F, Murayama S

    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)   2019.9

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    Analyses of size and computed tomography densitometry parameters for prediction of keloid recurrence after postoperative electron beam radiation therapy.

    DOI: 10.1111/srt.12775

  • Papillary renal cell carcinoma with massive hematoma mimicking hemangioma. Reviewed International journal

    Hiraki Y, Okamoto D, Nishie A, Asayama Y, Ishigami K, Ushijima Y, Takayama Y, Fujita N, Eto M, Kinoshita F, Honda H

    Radiology case reports   14 ( 8 )   1003 - 1006   2019.8

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    Papillary renal cell carcinoma with massive hematoma mimicking hemangioma.
    It is extremely rare that papillary renal cell carcinoma has a massive hemorrhage. We report a case of papillary renal cell carcinoma with a massive hemorrhage which showed hemangioma-like imaging findings such as a globular discontinuous enhancement on the corticomedullary phase with a gradual centripetal fill-in pattern on the excretory phase on computed tomography and heterogeneously hyperintensity on T2-weighted magnetic resonance imaging. We also discuss a plausible mechanism explaining such imaging findings, with reference to pathological findings.

    DOI: 10.1016/j.radcr.2019.05.025

  • Usefulness of a Pretreatment CT-Based Modified RENAL Nephrometry Score in Predicting Renal Function After Cryotherapy for T1a Renal Mass. Reviewed International journal

    Asayama Y, Nishie A, Ushijima Y, Okamoto D, Morita K, Takao S, Kakihara D, Ishimatsu K, Ishigami K, Fujita N, Honda H

    Cardiovascular and interventional radiology   42 ( 8 )   1128 - 1134   2019.8

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    Usefulness of a Pretreatment CT-Based Modified RENAL Nephrometry Score in Predicting Renal Function After Cryotherapy for T1a Renal Mass.
    PURPOSE: We investigated the usefulness of the modified RENAL nephrometry (mRN) scoring system for predicting post-cryotherapy renal function in patients with T1a renal mass. PATIENTS AND METHODS: A total of 75 patients with a T1a renal mass were enrolled. The mRN score was determined based on the tumor size, the tumor's exophytic/endophytic properties, the tumor's nearness to the collecting system, and the anterior/posterior location of the kidney. The change in the estimated glomerular filtration rate (ΔeGFR) was calculated as follows: ΔeGFR = 100 × ([pretreatment eGFR - eGFR at 6 months after cryotherapy]/pretreatment eGFR). Based on the ΔeGFR results, we classified the patients into two groups: a preserved renal function group (ΔeGFR < 10&#37;) and an impaired renal function group (ΔeGFR ≥ 10&#37;). We then analyzed the relationships between the mRN score and ΔeGFR and between the mRN score and the chronic kidney disease (CKD) stage. RESULTS: The mean ΔeGFR for all patients was 5.5&#37;. The mRN scores of the preserved renal function group (5.8 ± 0.3) were significantly lower than those of the impaired group (7.4 ± 0.3) (p < 0.001). When the mRN score cutoff value was set at 7 points, the mRN had 67.7&#37; sensitivity, 72.7&#37; specificity, 61.8&#37; positive predictive value (PPV), 76.1&#37; negative predictive value (NPV), and 70.7&#37; accuracy for predicting impaired renal function. For predicting a deterioration of CKD stage, the mRN had 92.9&#37; sensitivity, 67.2&#37; specificity, 39.4&#37; PPV, 97.6&#37; NPV, and 72&#37; accuracy. CONCLUSION: Our newly proposed modified RENAL nephrometry score was suggested to be useful for predicting renal function after renal cryotherapy.

    DOI: 10.1007/s00270-019-02238-1

  • Prediction of Liver Fibrosis Using CT Under Respiratory Control: New Attempt Using Deformation Vectors Obtained by Non-rigid Registration Technique. Reviewed International journal

    Akihiro Nishie, Sadato Akahori, Yoshiki Asayama, Kousei Ishigami, Yasuhiro Ushijima, Daisuke Kakihara, Tomohiro Nakayama, Yukihisa Takayama, Nobuhiro Fujita, Koichiro Morita, Keisuke Ishimatsu, Seiichiro Takao, Tomoharu Yoshizumi, Kenichi Kohashi, Yuanzhong Li, Hiroshi Honda

    Anticancer research   39 ( 3 )   1417 - 1424   2019.3

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    AIM: To investigate whether liver fibrosis can be predicted by quantifying the deformity of the liver obtained based on computed tomographic (CT) images scanned under respiratory control. MATERIALS AND METHODS: For dynamic CT of 47 patients, portal venous and equilibrium phases were scanned during inspiration and expiration, respectively. After rigid registration of the two images, non-rigid registration of the liver was performed, and the amount and direction of each voxel's shift during non-rigid registration was defined as the deformation vector. The correlation of each CT parameter for the obtained deformation vectors with the pathologically-proven degree of liver fibrosis was assessed using Spearman's rank correlation test. Receiver operating characteristic curve analysis was conducted for prediction of liver fibrosis. RESULTS: The standard deviation, coefficient of variance (CV) and skewness were significantly negatively correlated with the degree of liver fibrosis (p=0.030, 0.009 and 0.037, respectively). Of these measures, CV was best correlated and significantly decreased as liver fibrosis progressed (rho=-0.376). CV showed accuracies of 66.0-70.2&#37;, and the areas under curves were 0.654-0.727 for prediction of fibrosis of grade F1 or greater, F2 or greater, F3 or greater and F4 fibrosis. CONCLUSION: The deformation vector is a potential CT parameter for evaluating liver fibrosis.

    DOI: 10.21873/anticanres.13257

  • Impact of body mass index on CT attenuation of adrenal adenoma. Reviewed International journal

    Nishie A, Asayama Y, Ishigami K, Ushijima Y, Kakihara D, Nakayama T, Fujita N, Morita K, Ishimatsu K, Takao S, Hida T, Sugimoto M, Honda H

    European journal of radiology   108   184 - 188   2018.11

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    Impact of body mass index on CT attenuation of adrenal adenoma.
    OBJECTIVE: To investigate whether lipid metabolism-related factors regulate unenhanced CT attenuation in adrenal adenoma (AA). MATERIALS AND METHODS: Thirty-six patients with surgically proven AAs were enrolled in this study. The patients' underlying diseases were the following: primary aldosteronism (n = 24), Cushing's syndrome (n = 8), subclinical Cushing's syndrome (n = 3) and non-functioning AA (n = 1). Unenhanced CT attenuation of AAs and liver was measured. Pathologically, clear cell ratio (CCR) constituting each AA was qualitatively assessed. Clinical data including tumor diameter, body mass index (BMI), hemoglobin A1c, triglyceride, total cholesterol, blood cortisol and plasma aldosterone levels were also obtained. Simple and multiple linear regression analyses were performed to evaluate the radiological and clinicopathological factors associated with CT attenuation of AAs for all patients and separately for 25 patients with primary aldosteronism or non-functioning AA. RESULTS: For all patients, there was a significant correlation between CT attenuation and each of CCR, BMI and blood cortisol levels (p < 0.05). For patients with primary aldosteronism or non-functioning AA, there was also a significant correlation between CT attenuation and CCR or BMI (p < 0.05). CONCLUSION: In addition to pathological factors, lipid-metabolism-related factors including BMI and blood cortisol levels can affect unenhanced CT attenuation of AA.

    DOI: 10.1016/j.ejrad.2018.09.033

  • Amide proton transfer imaging can predict tumor grade in rectal cancer Reviewed

    Akihiro Nishie, Yukihisa Takayama, Yoshiki Asayama, Kousei Ishigami, Yasuhiro Ushijima, Daisuke Okamoto, Nobuhiro Fujita, Daisuke Tsurumaru, Osamu Togao, Tatsuya Manabe, Eiji Oki, Yuichiro Kubo, Tomoyuki Hida, Minako Hirahashi-Fujiwara, Jochen Keupp, Hiroshi Honda

    Magnetic Resonance Imaging   51   96 - 103   2018.9

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    Purpose: To prospectively investigate the ability of amide proton transfer (APT) imaging, in comparison with that of diffusion-weighted imaging (DWI), to predict pathological factors in rectal cancer. Materials and methods: Twenty-two patients who underwent MR examination including APT imaging and DWI for evaluation of rectal cancer were enrolled. APT signal intensity (SI) was defined as the magnetization transfer asymmetry at 3.5 ppm and was mapped. An apparent diffusion coefficient (ADC) map was generated using b-values of 0, 500 and 1000 s/mm2. APT SI and ADC were calculated by placing regions-of-interest in the tumors on these maps. Pathological factors including tumor size and tumor grade were also evaluated. Average APT SIs or ADCs were compared between the two groups classified based on each pathological factor using Student's t-test. Results: The average APT SI of tumors with diameters of 5 cm or more (3.09 ± 1.41&#37;) was significantly higher than that of tumors with diameters &lt
    5 cm (1.83 ± 1.38&#37;). In addition, the average APT SI of moderately differentiated adenocarcinoma (2.82 ± 1.51&#37;) was significantly higher than that of well-differentiated adenocarcinoma (1.24 ± 0.57&#37;). There was no difference in ADC between groups classified based on any pathological factor. Conclusion: Amide proton transfer imaging can predict tumor grade in rectal cancer.

    DOI: 10.1016/j.mri.2018.04.017

  • Clinical and Pathological Features of Solid Pseudopapillary Neoplasms of the Pancreas: A Nationwide Multicenter Study in Japan. Reviewed International journal

    Keiji Hanada, Keisuke Kurihara, Takao Itoi, Akio Katanuma, Tamito Sasaki, Kazuo Hara, Masafumi Nakamura, Wataru Kimura, Yutaka Suzuki, Masanori Sugiyama, Nobuyuki Ohike, Noriyoshi Fukushima, Michio Shimizu, Kousei Ishigami, Toshifumi Gabata, Kazuichi Okazaki

    Pancreas   47 ( 8 )   1019 - 1026   2018.9

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    OBJECTIVE: The aim of this study was to evaluate the clinicopathological features of solid pseudopapillary neoplasms (SPNs). METHODS: In this retrospective study, 288 SPNs were analyzed. RESULTS: Overall, 214 patients (74&#37;) were female. Distant metastases occurred in 4 patients, and splenic vein tumor thrombus occurred in 1 patient. Although imaging findings showed large (>2.0 cm) SPNs with clear, regular border, and heterogeneous internal structure, small SPNs appeared as almost entirely solid. Surgical resection was performed in 278 cases. The 5-year survival rate was 98.8&#37;. Six patients had tumor recurrence after the initial resection. The detection rate in typical pathological findings was low for small SPNs. Tumor extension to the pancreatic parenchyma was detected in greater than 70&#37; of the cases. Tumor invasion to adjacent organs was detected in 13 cases. One was given a diagnosis of apparent high-grade malignant transformation. CONCLUSIONS: The proportion of male cases was higher than that in previous studies, and there were statistically significant differences in the onset age and tumor diameter between male and female patients. Therefore, women seemed to have an early occurrence of SPNs, suggesting a difference in the developmental stage between men and women. Images and pathological findings of SPNs varied according to tumor size. Our findings indicated that SPN patients have excellent survival after margin-negative surgical resection.

    DOI: 10.1097/MPA.0000000000001114

  • Intrapancreatic recurrence of intraductal tubulopapillary neoplasm (ITPN) 16 years after the initial surgery for noninvasive ITPN: a case report. Reviewed International journal

    Saeki K, Miyasaka Y, Ohishi Y, Yamamoto T, Matsuda R, Mochidome N, Mori Y, Nakata K, Ohtsuka T, Ishigami K, Minoda Y, Koga Y, Oda Y, Nakamura M

    Surgical case reports   4 ( 1 )   96 - 96   2018.8

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    Intrapancreatic recurrence of intraductal tubulopapillary neoplasm (ITPN) 16 years after the initial surgery for noninvasive ITPN: a case report.
    BACKGROUND: Intraductal tubulopapillary neoplasm (ITPN) is a rare pancreatic intraductal neoplasm. It is characterized by a tubulopapillary growth pattern, entirely high-grade atypical cells, minimal cytoplasmic mucin, and no obvious luminal mucin secretion. Most of its biological nature remains unclear. CASE PRESENTATION: We herein report a case of intrapancreatic recurrence of ITPN in the remnant pancreas of a patient who underwent pancreatoduodenectomy 16 years previously for a noninvasive intraductal pancreatic head tumor. We reexamined the primary tumor and compared it with the most recently resected specimen. Histologically, the primary tumor showed a tubulopapillary growth of high-grade atypical cells with scanty cytoplasmic mucin, which was similar to the recently resected specimen except for the invasive area. Immunohistochemically, the neoplastic cells in both specimens showed focal staining of MUC1 and positivity for MUC6 but negativity for MUC2, MUC5AC, CDX2, and trypsin. Molecular analysis revealed no KRAS/GNAS/BRAF/PIK3CA mutations in either of the specimens. CONCLUSIONS: These findings of the original tumor and recently resected tumor were compatible with the features of ITPN. Thus, recurrence is possible even for a primary noninvasive ITPN, and long-term surveillance is recommended.

    DOI: 10.1186/s40792-018-0497-1

  • Relationship Among Tumor Attenuation Value of Pre-contrast Computed Tomography (CT), Washout Rate and Constituent Cells in Adrenal Adenoma: Proposition of a New Approach for Diagnosing Adrenal Adenoma on Dynamic CT. Reviewed International journal

    Nishie A, Sugimoto M, Asayama Y, Ishigami K, Ushijima Y, Takayama Y, Okamoto D, Fujita N, Yokomizo A, Tatsugami K, Honda H

    Anticancer research   38 ( 8 )   4767 - 4773   2018.8

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    Relationship Among Tumor Attenuation Value of Pre-contrast Computed Tomography (CT), Washout Rate and Constituent Cells in Adrenal Adenoma: Proposition of a New Approach for Diagnosing Adrenal Adenoma on Dynamic CT.
    AIM: To elucidate the relationship among tumor attenuation of pre-contrast-enhanced (TApre) computed tomography (CT), washout rate and clear cell ratio (CCR) in adrenal adenoma (AA) and propose a new approach for diagnosing AA on dynamic CT. MATERIALS AND METHODS: The training set consisted of 43 AAs and 15 non-AAs, while the validation set comprised 44 AAs and 11 non-AAs. Using the training set, the pairwise correlation between CCR, TApre and washout rate in AA was evaluated by linear regression analysis. A predictive formula for diagnosing AA was established by multiple logistic regression analysis using washout rate and TApre. Using the validation set, the diagnostic performance of this formula was investigated by comparing with the conventional diagnostic criteria: TApre ≤10 HU or washout rate ≥an optimal threshold calculated in the training set. RESULTS: Washout rate increased as CCR decreased, and as TApre increased. The formula predicting the probability of AA was: p(AA)=1/{1+exp(-1.5257+0.4923× TApre-0.3264×washout rate)}. Diagnostic performance of this formula was sensitivity of 93.2&#37; and accuracy of 89.1&#37;, while for the conventional diagnostic criteria, sensitivity was 81.8-86.4&#37; and accuracy 81.8-83.6&#37;. CONCLUSION: The diagnostic potential of dynamic CT for diagnosing AA may be improved by changing the threshold of washout rate based on substituting TApre for CCR.

    DOI: 10.21873/anticanres.12785

  • A case of pseudoglandular hepatocellular carcinoma: The usefulness of a multimodal approach. Reviewed International journal

    Hirofumi Watanabe, Yoshiki Asayama, Akihiro Nishie, Kousei Ishigami, Yasuhiro Ushijima, Daisuke Okamoto, Nobuhiro Fujita, Tomoharu Yoshizumi, Yoshinao Oda, Hiroshi Honda

    Radiology case reports   13 ( 3 )   689 - 692   2018.6

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    Hepatocellular carcinoma (HCC) mainly composed of the pseudoglandular pattern is very rare. We present a case of pseudoglandular HCC that was hyperechoic on ultrasound, with strongly high signal intensity on T2-weighted imaging and weak arterial contrast enhancement. Computed tomography hepatic arteriography showed corona enhancement. Radiologists should keep in mind this combination of multimodal radiological findings for pseudoglandular HCC.

    DOI: 10.1016/j.radcr.2018.03.022

  • Preoperative Muscle Volume Predicts Graft Survival After Pancreas Transplantation: A Retrospective Observational Cohort Study Reviewed

    H. Noguchi, Y. Miyasaka, K. Kaku, K. Kurihara, U. Nakamura, Y. Okabe, T. Ohtsuka, K. Ishigami, M. Nakamura

    Transplantation Proceedings   50 ( 5 )   1482 - 1488   2018.6

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    Background: Several studies have suggested that decreased muscle volume is associated with attenuation of immune function. The recipient's immune system is responsible for rejection of transplanted organs, which is a major cause of graft loss after transplantation. We aimed to determine whether muscle volume is correlated with graft survival after pancreas transplantation (PT). Methods: Forty-three patients underwent PT for type 1 diabetes mellitus at our institution from August 2001 to May 2016. The quantity of skeletal muscle was evaluated using the psoas muscle mass index (PMI). The correlation between PMI and outcome after PT was assessed. Results: A total of 32 and 11 recipients underwent simultaneous pancreas–kidney transplantation (SPK) and PT alone/pancreas after kidney transplantation, respectively. Patients with a surviving graft showed a significantly lower PMI than those with graft loss (P =.0451). We divided the recipients into two groups according to the PMI cutoff values, which were established using receiver operating characteristic curves. The cumulative graft survival rate was significantly higher in patients with a low PMI (P =.0206). A multivariate Cox regression analysis revealed that a low PMI (P =.0075) is an independent predictive factor for better graft survival. A low PMI was not a significant predictive factor for acute rejection, but was an independent predictive factor for graft survival after the first acute rejection (P =.0025). Conclusions: Our data suggest that muscle volume could be a predictor of graft survival after PT.

    DOI: 10.1016/j.transproceed.2018.03.018

  • Amide proton transfer imaging to predict tumor response to neoadjuvant chemotherapy in locally advanced rectal cancer. Reviewed International journal

    Nishie A, Asayama Y, Ishigami K, Ushijima Y, Takayama Y, Okamoto D, Fujita N, Tsurumaru D, Togao O, Sagiyama K, Manabe T, Oki E, Kubo Y, Hida T, Hirahashi-Fujiwara M, Keupp J, Honda H

    Journal of gastroenterology and hepatology   34 ( 1 )   140 - 146   2018.6

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    Amide proton transfer imaging to predict tumor response to neoadjuvant chemotherapy in locally advanced rectal cancer.
    BACKGROUND AND AIM: The amount of proteins and peptides can be estimated with amide proton transfer (APT) imaging. Previous studies demonstrated the usefulness of APT imaging to predict tumor malignancy. We determined whether APT imaging can predict the tumor response to neoadjuvant chemotherapy (NAC) in patients with locally advanced rectal cancer (LARC). METHODS: Seventeen patients with LARC who underwent a pretherapeutic magnetic resonance examination including APT imaging and NAC (at least two courses) were enrolled. The APT-weighted imaging (WI) signal intensity (SI) (&#37;) was defined as magnetization transfer ratio asymmetry (MTRasym ) at the offset of 3.5 ppm. Each tumor was histologically evaluated for the degree of degeneration and necrosis and then classified as one of five histological Grades (0, none; 1a, less than 1/3; 1b, 1/3 to 2/3; 2, more than 2/3; 3, all). We compared the mean APTWI SIs of the tumors between the Grade 0/1a/1b (low-response group) and Grade 2/3 (high-response group) by Student's t-test. We used receiver operating characteristics curves to determine the diagnostic performance of the APTWI SI for predicting the tumor response. RESULTS: The mean APTWI SI of the low-response group (n = 12; 3.05 ± 1.61&#37;) was significantly higher than that of the high-response group (n = 5; 1.14 ± 1.13&#37;) (P = 0.029). The area under the curve for predicting the tumor response using the APTWI SI was 0.87. When ≥2.75&#37; was used as an indicator of low-response status, 75&#37; sensitivity and 100&#37; specificity of the APTWI SI were obtained. CONCLUSION: Pretherapeutic APT imaging can predict the tumor response to NAC in patients with LARC.

    DOI: 10.1111/jgh.14315

  • The prevalence of transpancreatic common hepatic artery and coexisting variant anatomy. Reviewed International journal

    Kousei Ishigami, Akihiro Nishie, Yoshiki Asayama, Yasuhiro Ushijima, Yukihisa Takayama, Daisuke Okamoto, Nobuhiro Fujita, Tomoharu Yoshizumi, Norifumi Harimoto, Takao Ohtsuka, Kohei Nakata, Hiroshi Honda

    Clinical anatomy (New York, N.Y.)   31 ( 4 )   598 - 604   2018.5

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    We studied the prevalence of the transpancreatic common hepatic artery (tp-CHA) and coexisting variant anatomy. The study group comprised 788 consecutive liver transplant donor candidates who had undergone thin-section multidetector-row computed tomography (MDCT) studies to investigate vascular anatomy. Multiplanar reformatted (MPR) images obtained from the arterial phase were retrospectively reviewed to assess the presence/absence of the tp-CHA. Five cases of tp-CHA with pancreaticobiliary tumors were also included in an investigation of the presence/absence of variant hepatic arteries, celiac stenosis, and circumportal pancreas. Three of the 788 (0.38&#37;) donor candidates had a tp-CHA. Overall, eight tp-CHA cases were assessed for coexisting variant anatomy. Seven of these eight cases had a hepatomesenteric trunk, six had celiac stenosis, and two had a circumportal pancreas. The prevalence of the tp-CHA was 0.38&#37; (approx. one in 260 in normal populations). A tp-CHA can commonly be associated with a hepatomesenteric trunk and celiac stenosis. A circumportal pancreas can also coexist with a tp-CHA. Clin. Anat. 31:598-604, 2018. © 2017 Wiley Periodicals, Inc.

    DOI: 10.1002/ca.22957

  • The prevalence of transpancreatic common hepatic artery and coexisting variant anatomy Reviewed

    Kosei Ishigami, Akihiro Nishie, Yoshiki Asayama, yasuhiro ushijima, Yukihisa Takayama, Daisuke Okamoto, nobuhiro fujita, Tomoharu Yoshizumi, Norifumi Harimoto, Ohtsuka Takao, Kohei Nakata, Hiroshi Honda

    Clinical Anatomy   31 ( 4 )   598 - 604   2018.5

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    We studied the prevalence of the transpancreatic common hepatic artery (tp-CHA) and coexisting variant anatomy. The study group comprised 788 consecutive liver transplant donor candidates who had undergone thin-section multidetector-row computed tomography (MDCT) studies to investigate vascular anatomy. Multiplanar reformatted (MPR) images obtained from the arterial phase were retrospectively reviewed to assess the presence/absence of the tp-CHA. Five cases of tp-CHA with pancreaticobiliary tumors were also included in an investigation of the presence/absence of variant hepatic arteries, celiac stenosis, and circumportal pancreas. Three of the 788 (0.38%) donor candidates had a tp-CHA. Overall, eight tp-CHA cases were assessed for coexisting variant anatomy. Seven of these eight cases had a hepatomesenteric trunk, six had celiac stenosis, and two had a circumportal pancreas. The prevalence of the tp-CHA was 0.38% (approx. one in 260 in normal populations). A tp-CHA can commonly be associated with a hepatomesenteric trunk and celiac stenosis. A circumportal pancreas can also coexist with a tp-CHA. Clin. Anat. 31:598–604, 2018.

    DOI: 10.1002/ca.22957

  • Tumor enhancement on dynamic CT: A predictive factor for recurrence after nephrectomy in localized T1 clear cell renal cell carcinoma Reviewed

    Junki Maehara, Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Yasuhiro Ushijima, Yukihisa Takayama, Daisuke Okamoto, Nobuhiro Fujita, Masaaki Sugimoto, Junichi Inokuchi, Hiroshi Honda

    Anticancer Research   38 ( 4 )   2377 - 2383   2018.4

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    Aim: To investigate whether radiological parameters obtained on dynamic computed tomography (CT), especially those related to tumor enhancement, are predictive factors for recurrence after nephrectomy in localized stage T1 clear cell renal cell carcinoma (ccRCC). Materials and Methods: We retrospectively studied 88 patients with localized stage T1 ccRCC who underwent dynamic CT preoperatively. Seven patients had recurrent disease after surgery. Tumor attenuations were measured by placing a region of interest in the solid region. TApre and TAneph were defined as the tumor attenuation values of the pre-contrast and nephrographic phase, respectively. The correlations between disease-free survival and clinicopathological factors, including the radiological parameter TAneph – TApre (ΔTAneph), were analyzed by Cox proportional hazards model or Kaplan–Meier method with the log-rank test. Results: Only ΔTAneph was significantly and positively correlated with disease-free survival (p&lt
    0.05). Tumor size also tended to be negatively correlated with disease-free survival (p&lt
    0.1). The 5- and 10-year disease-free survival rates of the group with high ΔTAneph (≥86 HU) were 97.4&#37; and 97.4&#37;, while those of the group with low ΔTAneph (&lt
    86 HU) were 89.6&#37; and 71.6&#37;, respectively. Conclusion: Tumor enhancement in the nephrographic phase of CT was a predictive factor for recurrence after nephrectomy in patients with localized stage T1 ccRCC.

    DOI: 10.21873/anticanres.12486

  • Amide proton transfer MR imaging of endometrioid endometrial adenocarcinoma: Association with histologic grade Reviewed

    Yukihisa Takayama, Akihiro Nishie, Osamu Togao, Yoshiki Asayama, Kousei Ishigami, Yasuhiro Ushijima, Daisuke Okamoto, Nobuhiro Fujita, Kenzo Sonoda, Tomoyuki Hida, Yoshihiro Ohishi, Jochen Keupp, Hiroshi Honda

    Radiology   286 ( 3 )   909 - 917   2018.3

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    Purpose: To evaluate the utility of amide proton transfer (APT) imaging in estimating histologic grades of endometrioid endometrial adenocarcinoma (EEA). Materials and The institutional review board approved this prospective Methods: study. Between June 2012 and March 2016, 32 patients with EEA underwent magnetic resonance (MR) imaging. After their surgical procedures, their EEAs were confirmed pathologically and classified into histologic grades: grade 1 (n = 11), grade 2 (n = 11), and grade 3 (n = 10). The APT signal intensities (SIs) and the mean and minimum apparent diffusion coefficients (ADCs) of the three grades were calculated and compared. Spearman rank correlation coefficient was also calculated between the APT SIs and histologic grades, and between the ADCs and histologic grades. Results: The Spearman correlation coefficient with histologic grade of the APT SIs, the mean ADC, and the minimum ADC were 0.55 (P = .001), 0.03 (P = .84), and 20.30 (P = .09), respectively. The average APT SIs and the mean and minimum ADCs were 2.2&#37; 6 0.2 (standard deviation), 0.9 3 1023 mm2/sec 6 0.2, and 0.6 3 1023 mm2/sec 6 0.1 for grade 1
    3.2&#37; 6 0.3, 0.8 3 1023 mm2/sec 6 0.1, and 0.5 3 1023 mm2/sec 6 0.1 for grade 2
    and 3.7&#37; 6 0.3, 0.9 3 1023 mm2/sec 6 0.1, and 0.5 3 1023 mm2/sec 6 0.1 for grade 3, respectively. The APT SIs of grade 3 EEA were significantly higher than those of grade 1 EEA (P = .01), but other pairwise comparisons did not reveal any significant differences (P = .06-.51). The mean and minimum ADCs showed no significant differences among the three histologic grades (P =.13-.51). Conclusion: The APT SI was positively correlated with the histologic grades of EEA.

    DOI: 10.1148/radiol.2017170349

  • Mucinous nonneoplastic cyst of the pancreas: CT and MRI appearances Reviewed

    Kousei Ishigami, Akihiro Nishie, Naoki Mochidome, Yoshiki Asayama, Yasuhiro Ushijima, Daisuke Kakihara, Daisuke Okamoto, Nobuhiro Fujita, Takao Ohtsuka, Yoshihiro Miyasaka, Tomoyuki Hida, Tomoharu Yoshizumi, Hiroshi Honda

    ABDOMINAL RADIOLOGY   42 ( 12 )   2827 - 2834   2017.12

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    The purpose of this retrospective study was to evaluate imaging features of mucinous nonneoplastic cyst (MNNC) of the pancreas.
    Three (0.9&#37;) patients with MNNC of the pancreas were found in 335 surgically resected pancreatic cystic lesions. Three MDCT and two MRI/MRCP studies were retrospectively reviewed.
    Three cases of MNNC were found in the pancreatic neck, body, and tail, respectively. All the three cases were multilocular without communication with the main pancreatic duct (MPD), although upstream MPD dilatation was seen in two of the three cases. The signal intensity of the cyst fluid was low on T1-weighted, high on T2-weighted, and low on diffusion-weighted images. Cyst wall was thin in two cases, and the remaining case with obstructive pancreatitis showed visible cyst wall enhancement.
    Imaging findings of MNNC of the pancreas were nonspecific without communication with the MPD. Cyst wall is typically thin without visible enhancement.

    DOI: 10.1007/s00261-017-1204-6

  • Differential Diagnosis of Pancreatic Epidermoid Cyst Without a Solid Component (Residual Splenic Tissue) vs. Mucinous Cystic Neoplasm Reviewed

    Kosei Ishigami, Akihiro Nishie, Hiroyuki Irie, Yoshiki Asayama, yasuhiro ushijima, Yukihisa Takayama, Daisule Okamoto, nobuhiro fujita, Ohtsuka Takao, Tetsuhide Ito, Naoki Mochidome, Hiroshi Honda

    Journal of Gastrointestinal Cancer   1 - 7   2017.12

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    Purpose: The purpose of this study was to clarify whether there are differences in imaging findings between pancreatic epidermoid cyst (EDC) without a solid component (residual splenic tissue) and mucinous cystic neoplasm (MCN). Materials and Methods: The study group consisted of histologically proven EDC (eight cases) and MCN (20 cases). CT and MRI findings were compared on the following imaging findings: the shape of the cystic lesions and the presence or absence of septum, calcification, and high-intensity fluid on T1- and diffusion-weighted images (b factor = 1000). The degree of contact with the pancreatic tail was compared between the EDCs and six of the MCNs at the edge of the pancreatic tail. Results: The EDCs were round (n = 3) or oval (n = 5), while the MCNs consisted of three round, five oval, six pear-like, and six multilobulated lesions (P < 0.05). Septum was present in 4 of 8 (50%) EDCs and 19 of 20 (95%) MCNs (P < 0.05). The presence of calcification (2 of 8 [25%] EDCs vs. 8 of 20 [40%] MCNs), high-intensity fluid on T1-weighted images (2 of 7 [29%] EDCs vs. 5 of 20 [25%] MCNs), and high-intensity fluid on diffusion-weighted images (5 of 7 [71%] EDCs vs. 5 of 20 [25%] MCNs) were not significantly different. The degree of contact with the pancreatic parenchyma was similar between the two types of lesions. Conclusion: Although the imaging findings for EDC without a solid component and MCN overlap, a pear-like or multilobulated shape may favor a diagnosis of MCN.

    DOI: 10.1007/s12029-017-0035-6

  • Differential Diagnosis of Pancreatic Epidermoid Cyst Without a Solid Component (Residual Splenic Tissue) vs. Mucinous Cystic Neoplasm Reviewed

    Kousei Ishigami, Akihiro Nishie, Hiroyuki Irie, Yoshiki Asayama, Yasuhiro Ushijima, Yukihisa Takayama, Daisule Okamoto, Nobuhiro Fujita, Takao Ohtsuka, Tetsuhide Ito, Naoki Mochidome, Hiroshi Honda

    Journal of Gastrointestinal Cancer   1 - 7   2017.12

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    Purpose: The purpose of this study was to clarify whether there are differences in imaging findings between pancreatic epidermoid cyst (EDC) without a solid component (residual splenic tissue) and mucinous cystic neoplasm (MCN). Materials and Methods: The study group consisted of histologically proven EDC (eight cases) and MCN (20 cases). CT and MRI findings were compared on the following imaging findings: the shape of the cystic lesions and the presence or absence of septum, calcification, and high-intensity fluid on T1- and diffusion-weighted images (b factor = 1000). The degree of contact with the pancreatic tail was compared between the EDCs and six of the MCNs at the edge of the pancreatic tail. Results: The EDCs were round (n = 3) or oval (n = 5), while the MCNs consisted of three round, five oval, six pear-like, and six multilobulated lesions (P &lt
    0.05). Septum was present in 4 of 8 (50&#37;) EDCs and 19 of 20 (95&#37;) MCNs (P &lt
    0.05). The presence of calcification (2 of 8 [25&#37;] EDCs vs. 8 of 20 [40&#37;] MCNs), high-intensity fluid on T1-weighted images (2 of 7 [29&#37;] EDCs vs. 5 of 20 [25&#37;] MCNs), and high-intensity fluid on diffusion-weighted images (5 of 7 [71&#37;] EDCs vs. 5 of 20 [25&#37;] MCNs) were not significantly different. The degree of contact with the pancreatic parenchyma was similar between the two types of lesions. Conclusion: Although the imaging findings for EDC without a solid component and MCN overlap, a pear-like or multilobulated shape may favor a diagnosis of MCN.

    DOI: 10.1007/s12029-017-0035-6

  • Predictors of therapeutic effect of transarterial chemoembolisation using drug-eluting beads for hepatocellular carcinoma Reviewed

    Y. Asayama, D. Okamoto, Y. Ushijima, A. Nishie, K. Ishigami, Y. Takayama, N. Fujita, H. Honda

    CLINICAL RADIOLOGY   72 ( 9 )   780 - 785   2017.9

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    AIMS: To identify predictors of a therapeutic effect after transarterial chemoembolisation using drug-eluting beads (DEB-TACE) for hepatocellular carcinoma (HCC).
    MATERIALS AND METHODS: Between January 2015 and July 2015, tumour variables and angiographic data were collected for 25 patients (49 target lesions) after they had undergone the DEB-TACE procedure for HCC. The therapeutic effect was evaluated according to the Response Evaluation Criteria in Cancer of the Liver at follow-up dynamic computed tomography (CT) performed within 1-4 months after the procedure. A p<0.05 was considered significant.
    RESULTS: On a target lesion basis, the objective response (TE3/4) rate was 63.3&#37; (31 of 49). On univariate analysis, larger size (>= 2 cm) was a predictor of an objective response (p=0.029). The tumour location of the medial (segment 4) or caudate (segment 1) lobe also indicated a poor therapeutic effect (TE1/2), but not at the level of significance (p=0.051). Multivariate analysis identified tumour size (odds ratio, 8.60; 95&#37; confidence interval, 1.87-62.8) and tumour location (odds ratio, 12.2; 95&#37; confidence interval, 2.12-129.8) as significant factors associated with a therapeutic effect. On a patient basis, 10 of 25 (40&#37;) patients showed complete response/partial response. There were no significant differences between complete response/partial response and stable disease/progressive disease regarding age, gender, tumour markers, history of previous treatment, ChildePugh class, T-stage, or Barcelona Clinic Liver Cancer Staging.
    CONCLUSION: A short-term therapeutic effect was associated with tumour size and location on a target lesion basis. (C) 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

    DOI: 10.1016/j.crad.2017.03.023

  • Clinical significance of circumportal pancreas, a rare congenital anomaly, in pancreatectomy Reviewed

    Takao Ohtsuka, Yasuhisa Mori, Kousei Ishigami, Takaaki Fujimoto, Yoshihiro Miyasaka, Kohei Nakata, Kenoki Ohuchida, Eishi Nagai, Yoshinao Oda, Shuji Shimizu, Masafumi Nakamura

    AMERICAN JOURNAL OF SURGERY   214 ( 2 )   267 - 272   2017.8

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    Background: Circumportal pancreas is a rare congenital pancreatic anomaly. The aim of this study was to clarify the clinical characteristics of patients with circumportal pancreases undergoing pancreatectomy.
    Methods: The medical records of 508 patients who underwent pancreatectomy were retrospectively reviewed. The prevalence of circumportal pancreas and related anatomical variations were assessed. Surgical procedures and postoperative outcomes were compared in patients with and without circumportal pancreas.
    Results: Circumportal pancreas was observed in 9 of the 508 patients (1.7&#37;). In all nine patients, the portal vein was completely encircled by the pancreatic parenchyma above the level of the splenoportal junction, and the main pancreatic duct ran dorsal to the portal vein. The rate of variant hepatic artery did not differ significantly in patients with and without circumportal pancreas. Pancreatic fistula developed more frequently in patients with than without circumportal pancreas (44&#37; vs. 14&#37;, p = 0.03), but other clinical parameters did not differ significantly in these two groups.
    Conclusions: Despite being rare, circumportal pancreas may increase the risk of postoperative pancreatic fistula in patients undergoing pancreatectomy. However, a prospective, large-cohort study is necessary to determine the real incidence of relevant anatomical variations and the definitive clinical significance of this rare anomaly.(c) 2016 Elsevier Inc. All rights reserved.

    DOI: 10.1016/j.amjsurg.2016.11.018

  • Prognostic significance of contrast-enhanced CT attenuation value in extrahepatic cholangiocarcinoma Reviewed

    Yoshiki Asayama, Akihiro Nishie, Kousei Ishigami, Yasuhiro Ushijima, Yukihisa Takayama, Daisuke Okamoto, Nobuhiro Fujita, Takao Ohtsuka, Tomoharu Yoshizumi, Shinichi Aishima, Yoshinao Oda, Hiroshi Honda

    EUROPEAN RADIOLOGY   27 ( 6 )   2563 - 2569   2017.6

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    To determine whether washout characteristics of dynamic contrast-enhanced computed tomography (CT) could predict survival in patients with extrahepatic cholangiocarcinoma (EHC).
    This study collected 46 resected cases. All cases were examined by dynamic contrast study on multidetector-row CT. Region-of-interest measurements were obtained at the non-enhanced, portal venous phase and delayed phase in the tumour and were used to calculate the washout ratio as follows: [(attenuation value at portal venous phase CT - attenuation value at delayed enhanced CT)/(attenuation value at portal venous phase CT - attenuation value at unenhanced CT)] x 100. On the basis of the median washout ratio, we classified the cases into two groups, a high-washout group and low-washout group. Associations between overall survival and various factors including washout rates were analysed.
    The median washout ratio was 29.4 &#37;. Univariate analysis revealed that a lower washout ratio, venous invasion, lymphatic permeation and lymph node metastasis were associated with shorter survival. Multivariate analysis identified the lower washout ratio as an independent prognostic factor (hazard ratio, 3.768; p value, 0.027).
    The washout ratio obtained from the contrast-enhanced CT may be a useful imaging biomarker for the prediction of survival of patients with EHC.
    aEuro cent Dynamic contrast study can evaluate the aggressiveness of extrahepatic cholangiocarcinoma.
    aEuro cent A lower washout ratio was an independent prognostic factor for overall survival.
    aEuro cent CT can predict survival and inform decisions on surgical options or chemotherapy.

    DOI: 10.1007/s00330-016-4621-y

  • Image quality and diagnostic performance of free-breathing diffusion-weighted imaging for hepatocellular carcinoma Reviewed

    Yukihisa Takayama, Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Daisuke Kakihara, Yasuhiro Ushijima, Nobuhiro Fujita, Ken Shirabe, Atsushi Takemura, Hiroshi Honda

    World Journal of Hepatology   9 ( 14 )   657 - 666   2017.5

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    AIM: To retrospectively evaluate the diagnostic performance of free-breathing diffusion-weighted imaging (FB-DWI) with modified imaging parameter settings for detecting hepatocellular carcinomas (HCCs). METHODS: Fifty-one patients at risk for HCC were scanned with both FB-DWI and respiratory-triggered DWI with the navigator echo respiratory-triggering technique (RTDWI). Qualitatively, the sharpness of the liver contour, the image noise and the chemical shift artifacts on each DWI with b -values of 1000 s/mm2 were independently evaluated by three radiologists using 4-point scoring. We compared the image quality scores of each observer between the two DWI methods, using the Wilcoxon signed-rank test. Quantitatively, we compared the signal-to-noise ratios (SNRs) of the liver parenchyma and lesion-to-nonlesion contrast-to-noise ratios (CNRs) after measuring the signal intensity on each DWI with a b-factor of 1000 s/mm2. The average SNRs and CNRs between the two DWI methods were compared by the paired t-test. The detectability of HCC on each DWI was also analyzed by three radiologists. The detectability provided by the two DWI methods was compared using McNemar's test. RESULTS: For all observers, the averaged image quality scores of FB-DWI were: Sharpness of the liver contour [observer (Obs)-1, 3.08 ± 0.81
    Obs-2, 2.98 ± 0.73
    Obs-3, 3.54 ± 0.75], those of the distortion (Obs-1, 2.94 ± 0.50
    Obs-2, 2.71 ± 0.70
    Obs-3, 3.27 ± 0.53), and the chemical shift artifacts (Obs-1, 3.38 ± 0.60
    Obs-2, 3.15 ± 1.07
    Obs-3, 3.21 ± 0.85). The averaged image quality scores of RTDWI were: Sharpness of the liver contour (Obs-1, 2.33 ± 0.65
    Obs-2, 2.37 ± 0.74
    Obs-3, 2.75 ± 0.81), distortion (Obs-1, 2.81 ± 0.56
    Obs-2, 2.25 ± 0.74
    Obs-3, 2.96 ± 0.71), and the chemical shift artifacts (Obs-1, 2.92 ± 0.59
    Obs-2, 2.21 ± 0.85
    Obs-3, 2.77 ± 1.08). All image quality scores of FB-DWI were significantly higher than those of RT-DWI (p &lt
    0.05). The average SNR of the normal liver parenchyma by FB-DWI (11.0 ± 4.8) was not significantly different from that shown by RT-DWI (11.0 ± 5.0)
    nor were the lesion-to-nonlesion CNRs significantly different (FB-DWI, 21.4 ± 17.7
    RT-DWI, 20.1 ± 15.1). For all three observers, the detectability of FB-DWI (Obs-1, 43.6&#37;
    Obs-2, 53.6&#37;
    and Obs-3, 45.0&#37;) was significantly higher than that of RT-DWI (Obs-1, 29.1&#37;
    Obs-2, 43.6&#37;
    and Obs-3, 34.5&#37;) (p &lt
    0.05). CONCLUSION: FB-DWI showed better image quality and higher detectability of HCC compared to RT-DWI, without significantly reducing the SNRs of the liver parenchyma and lesionto- nonlesion CNRs.

    DOI: 10.4254/wjh.v9.i14.657

  • Does apparent diffusion coefficient predict the degree of liver regeneration of donor and recipient after living donor liver transplantation? Reviewed

    Koichiro Morita, Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Yasuhiro Ushijima, Yukihisa Takayama, Daisuke Okamoto, Nobuhiro Fujita, Toru Ikegami, Tomoharu Yoshizumi, Ken Shirabe, Hiroshi Honda

    EUROPEAN JOURNAL OF RADIOLOGY   90   146 - 151   2017.5

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    Objective: To elucidate the relationship between the ADCs of the liver graft and the remnant liver and the degree of liver regeneration in LDLT.
    Materials and methods: 15 recipients and 15 corresponding donors underwent magnetic resonance imaging and computed tomography 1-2 weeks after living donor liver transplantation (LDLT). For diffusion-weighted imaging (DWI), a single-shot echo-planar sequence with b-factors of 0, 500, and 1000 s/mm(2) was scanned. ADCs of the liver parenchyma were calculated at b-factors of 0 and 500 and 1000 (ADC 0-500-1000) or 0 and 500 (ADC 0-500) or 500 and 1000 (ADC 500-1000). The liver volume ratio at LDLT, the mean ADCs and the regeneration rate were compared between the graft and the remnant liver using paired-t tests.
    Results: The mean liver volume ratio of the recipients (41.3 9.8&#37;) tended to be smaller than that of the donors (51.8 13.8&#37;). The mean ADC 0-500 of the remnant liver (1.72 0.33) was significantly higher than that of the graft (1.43 0.32). The regeneration rate of the graft (2.07 0.41) was significantly higher than that of the remnant liver (1.53 0.49).
    Conclusion: ADC 0-500 can describe differences in blood perfusion between liver grafts and the remnant liver according to the degree of liver regeneration. (C) 2017 Elsevier B.V. All rights reserved.

    DOI: 10.1016/j.ejrad.2017.02.041

  • Mass-forming intrahepatic cholangiocarcinoma: Enhancement patterns in the arterial phase of dynamic hepatic CT - Correlation with clinicopathological findings Reviewed

    Nobuhiro Fujita, Yoshiki Asayama, Akihiro Nishie, Kousei Ishigami, Yasuhiro Ushijima, Yukihisa Takayama, Daisuke Okamoto, Koichiro Moirta, Ken Shirabe, Shinichi Aishima, Huanlin Wang, Yoshinao Oda, Hiroshi Honda

    EUROPEAN RADIOLOGY   27 ( 2 )   498 - 506   2017.2

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    To evaluate the relationship between the enhancement pattern of intrahepatic cholangiocarcinomas (ICCs) in the hepatic arterial phase (HAP) of dynamic hepatic CT and the clinicopathological findings with special reference to the perihilar type and the peripheral type.
    Forty-seven patients with pathologically proven ICCs were enrolled. Based on the enhancement pattern in the HAP, the lesions were classified into three groups: a hypovascular group (n=13), rim-enhancement group (n=18), and hypervascular group (n=16). The clinicopathological findings were compared among the three groups.
    Perihilar-type ICCs were significantly more frequently observed in the hypovascular group than in the rim-enhancement and hypervascular groups (p=0.006 and p < 0.001, respectively). Lymphatic invasion, perineural invasion, and biliary invasion were significantly more frequent in the hypovascular group than the rim- enhancement group (p=0.001, p=0.025 and p=0.029, respectively) or hypervascular group (p < 0.001, p < 0.001 and p=0.025, respectively). Patients with hypovascular lesions showed significantly poorer disease-free survival than patients with rim-enhancing or hypervascular lesions (p=0.001 and p=0.001, respectively). Hypovascularity was an independent preoperative prognostic factor for disease-free survival (p < 0.001).
    Hypovascular ICCs in the HAP tend to be of perihilar type and to have more malignant potential than other ICCs.
    aEuro cent Hypovascular ICCs have greater malignant potential than rim-enhancing and hypervascular ICCs.
    aEuro cent Hypovascular ICCs show a higher frequency of perihilar-type ICCs.
    aEuro cent Perihilar-type ICCs do not always display distal ductal wall thickening.

    DOI: 10.1007/s00330-016-4386-3

  • Fatty change in moderately and poorly differentiated hepatocellular carcinoma on MRI: a possible mechanism related to decreased arterial flow Reviewed

    Y. Asayama, A. Nishie, K. Ishigami, Y. Ushijima, Y. Takayama, D. Okamoto, N. Fujita, Y. Kubo, S. Aishima, T. Yoshizumi, H. Honda

    CLINICAL RADIOLOGY   71 ( 12 )   1277 - 1283   2016.12

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    AIM: To clarify the frequency of fatty change in moderately and poorly differentiated hepatocellular carcinomas (mHCCs and pHCCs) and its relationship to arterial blood flow.
    MATERIALS AND METHODS: One hundred and thirty-six surgically resected HCC lesions were studied. All patients had undergone dynamic magnetic resonance imaging (MRI) with chemical-shift-encoded water-fat imaging (CSI). The presence of fat was identified by a signal drop-off on CSI and confirmed at pathology. Lesions were classified into four groups in the arterial phase; G1, hypointense; G2, isointense; G3, slightly and heterogeneously hyperintense; G4, markedly and homogeneously hyperintense. The number of cumulative arteries (CAs) in the tumours in the pathology examination were counted.
    RESULTS: A fat component was observed significantly more frequently in the pHCCs (13/21; 61.9&#37;) compared to the mHCCs (32/101; 31.7&#37;; p=0.013). The numbers of lesions in each group were as follows: (G1, G2, G3, G4) = (18, 9, 23, 4) in the HCCs with fat; (1, 6, 24, 51) in the HCCs without fat (p<0.001); (5, 5, 18, 4) in the mHCCs with fat; (0, 3, 19, 47) in the mHCCs without fat (p<0.001); (11, 0, 2, 0) in the pHCCs with fat; (0, 2, 3, 3) in the pHCCs without fat (p=0.001). The number of CAs in the fat-containing HCCs (5.5 +/- 2.9) was significantly lower than that in the HCCs without fat (10.8 +/- 5.3; p<0.001).
    CONCLUSION: A fat component was more commonly observed in the pHCCs than in the mHCCs. The present results showed a possible mechanism of fatty change in mHCCs and pHCCs in relation to decreased arterial blood supply. (C) 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

    DOI: 10.1016/j.crad.2016.04.020

  • Balanced MR cholangiopancreatography with motion-sensitised driven-equilibrium (MSDE) preparation: feasibility of Gd-EOB-DTPA-enhanced biliary examination Reviewed

    T. Nakayama, T. Yoshiura, A. Nishie, Y. Asayama, K. Ishigami, D. Kakihara, Y. Takayama, M. Hatakenaka, M. Obara, H. Honda

    CLINICAL RADIOLOGY   71 ( 12 )   1284 - 1288   2016.12

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    AIM: To evaluate the effectiveness of motion-sensitised driven-equilibrium (MSDE)-prepared balanced magnetic resonance cholangiopancreatography (MRCP) in a gadolinium ethoxybenzyl diethylene triamine pentaacetic acid (Gd-EOB-DTPA)-enhanced study compared to conventional T2-weighted MRCP.
    MATERIALS AND METHODS: Fifteen patients (seven male and eight female patients) prospectively underwent conventional three-dimensional turbo spin-echo T2-weighted MRCP and MSDE-balanced MRCP using a 1.5 T MRI system after hepatobiliary phase image acquisition. For quantitative evaluation, the contrast-to-noise ratio (CNR) of the common hepatic duct to liver tissue was calculated. For qualitative analysis, two radiologists evaluated the depiction of the biliary system and main pancreatic duct (MPD) using a scoring system. Signal suppression of the portal vein (PV) and hepatic vein (HV) on MSDE-balanced MRCP was also scored.
    RESULTS: MSDE-balanced MRCP showed significantly higher CNR than T2-weighted MRCP. For all biliary structures, the mean depiction scores of MSDE-balanced MRCP were significantly higher than those of T2-weighted MRCP, whereas the mean depiction score of MPD with MSDE-balanced MRCP was significantly lower than that of T2-weighted MRCP. Signal suppression of the PV and HV was thought to be clinically sufficient.
    CONCLUSIONS: MSDE-balanced MRCP more clearly depicted biliary structures compared with T2-weighted MRCP in a Gd-EOB-DTPA-enhanced study. This sequence may be utilised for routine MRCP on Gd-EOB-DTPA-enhanced MRI. (C) 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

    DOI: 10.1016/j.crad.2016.03.019

  • Fibrosis in nonalcoholic fatty liver disease: Noninvasive assessment using computed tomography volumetry Reviewed

    Nobuhiro Fujita, Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Yasuhiro Ushijima, Yukihisa Takayama, Daisuke Okamoto, Ken Shirabe, Tomoharu Yoshizumi, Kazuhiro Kotoh, Norihiro Furusyo, Tomoyuki Hida, Yoshinao Oda, Taisuke Fujioka, Hiroshi Honda

    WORLD JOURNAL OF GASTROENTEROLOGY   22 ( 40 )   8949 - 8955   2016.10

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    AIM
    To evaluate the diagnostic performance of computed tomography (CT) volumetry for discriminating the fibrosis stage in patients with nonalcoholic fatty liver disease (NAFLD).
    METHODS
    A total of 38 NAFLD patients were enrolled. On the basis of CT imaging, the volumes of total, left lateral segment (LLS), left medial segment, caudate lobe, and right lobe (RL) of the liver were calculated with a dedicated liver application. The relationship between the volume percentage of each area and fibrosis stage was analyzed using Spearman's rank correlation coefficient. A receiver operating characteristic (ROC) curve analysis was performed to determine the accuracy of CT volumetry for discriminating fibrosis stage.
    RESULTS
    The volume percentages of the caudate lobe and the LLS significantly increased with the fibrosis stage (r = 0.815, P < 0.001; and r = 0.465, P = 0.003, respectively). Contrarily, the volume percentage of the RL significantly decreased with fibrosis stage (r = -0.563, P < 0.001). The volume percentage of the caudate lobe had the best diagnostic accuracy for staging fibrosis, and the area under the ROC curve values for discriminating fibrosis stage were as follows: >= F1, 0.896; >= F2, 0.929; >= F3, 0.955; and >= F4, 0.923. The best cut-off for advanced fibrosis (F3-F4) was 4.789&#37;, 85.7&#37; sensitivity and 94.1&#37; specificity.
    CONCLUSION
    The volume percentage of the caudate lobe calculated by CT volumetry is a useful diagnostic parameter for staging fibrosis in NAFLD patients.

    DOI: 10.3748/wjg.v22.i40.8949

  • Histogram analysis of noncancerous liver parenchyma on gadoxetic acid-enhanced MRI: predictive value for liver function and pathology Reviewed

    Yoshiki Asayama, Akihiro Nishie, Kousei Ishigami, Yasuhiro Ushijima, Yukihisa Takayama, Daisuke Okamoto, Nobuhiro Fujita, Tomoharu Yoshizumi, Tomoyuki Hida, Hiroshi Honda

    ABDOMINAL RADIOLOGY   41 ( 9 )   1751 - 1757   2016.9

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    To clarify whether the heterogeneity of hepatic parenchyma in the hepatobiliary phase on gadoxetic acid-magnetic resonance (MR) imaging is correlated with liver damage.
    We retrospectively examined the cases of 98 patients with or without chronic liver disease who underwent gadoxetic acid-enhanced 3T MR imaging before a hepatectomy between December 2010 and October 2014. For the evaluation of the heterogeneity of the signal intensity in the hepatobiliary phase, we placed the region of interest on the hepatic parenchyma, and the skewness and kurtosis were calculated using ImageJ software. A discriminant analysis was performed to examine the routine preoperative laboratory test results including indocyanine green retention at 15 min (ICG-R15), necro-inflammation grade, and liver fibrosis stage according to the METAVIR system: A0/1 (n = 69) and A2 (n = 29); F0/1 (n = 47), F2/3 (n = 31), and F4 (n = 20).
    The combination of skewness and kurtosis could discriminate the high ICG-R15 (> 20) and low (< 20) groups (lambda; 0.925, p = 0.025), necro-inflammatory grade (lambda; 0.926, p = 0.026), and fibrosis stage (lambda; 0.752, p < 0.0001) with statistical significance. The difference between the patients with normal values and those with an abnormal platelet count or aspartate transaminase level was also detectable (lambda; 0.901, p < 0.007, and lambda; 0.864, p = 0.001, respectively).
    Histogram analyses of the hepatobiliary phase of gadoxetic acid-enhanced MR imaging have potential as a biomarker for the assessment of liver function, liver fibrosis, and necro-inflammation.

    DOI: 10.1007/s00261-016-0753-4

  • Amide proton transfer (APT) magnetic resonance imaging of prostate cancer: comparison with Gleason scores Reviewed

    Yukihisa Takayama, Akihiro Nishie, Masaaki Sugimoto, Osamu Togao, Yoshiki Asayama, Kousei Ishigami, Yasuhiro Ushijima, Daisuke Okamoto, Nobuhiro Fujita, Akira Yokomizo, Jochen Keupp, Hiroshi Honda

    MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE   29 ( 4 )   671 - 679   2016.8

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    To evaluate the utility of amide proton transfer (APT) imaging in estimating the Gleason score (GS) of prostate cancer (Pca).
    Sixty-six biopsy-proven cancers were categorized into four groups according to the GS: GS-6 (3 + 3); GS-7 (3 + 4/4 + 3); GS-8 (4 + 4) and GS-9 (4 + 5/5 + 4). APT signal intensities (APT SIs) and apparent diffusion coefficient (ADC) values of each GS group were compared by one-way analysis of variance with Tukey's HSD post hoc test.
    The mean and standard deviation of the APT SIs (&#37;) and ADC values (x10(-3) mm(2)/s) were as follows: GS-6, 2.48 +/- 0.59 and 1.16 +/- 0.26; GS-7, 5.17 +/- 0.66 and 0.92 +/- 0.18; GS-8, 2.56 +/- 0.85 and 0.86 +/- 0.17; GS-9, 1.96 +/- 0.75 and 0.85 +/- 0.18, respectively. The APT SI of the GS-7 group was highest, and there were significant differences between the GS-6 and GS-7 groups and the GS-7 and GS-9 groups (p < 0.05). The ADC value of the GS-6 group was significantly higher than each value of the GS-7, GS-8, and GS-9 groups (p < 0.05), but no significant differences were obtained among the GS-7, GS-8, and GS-9 groups.
    The mean APT SI in Pca with a GS of 7 was higher than that for the other GS groups.

    DOI: 10.1007/s10334-016-0537-4

  • Distinction of Invasive Carcinoma Derived From Intraductal Papillary Mucinous Neoplasms From Concomitant Ductal Adenocarcinoma of the Pancreas Using Molecular Biomarkers Reviewed

    Koji Tamura, Takao Ohtsuka, Kenjiro Date, Takaaki Fujimoto, Taketo Matsunaga, Hideyo Kimura, Yusuke Watanabe, Tetsuyuki Miyazaki, Kenoki Ohuchida, Shunichi Takahata, Kousei Ishigami, Yoshinao Oda, Kazuhiro Mizumoto, Masafumi Nakamura, Masao Tanaka

    PANCREAS   45 ( 6 )   826 - 835   2016.7

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    Objectives: To clarify the usefulness of molecular biomarkers for distinguishing invasive carcinoma derived from intraductal papillary mucinous neoplasms (IPMNs [Inv-IPMN]) from concomitant pancreatic ductal adenocarcinoma (PDAC).
    Methods: Data from 19 patients with resected concomitant PDAC were retrospectively reviewed. KRAS/GNAS mutations and immunohistochemical (IHC) expression of p53 and p16/CDKN2A were assessed in both IPMN and distinct PDAC. As controls, KRAS/GNAS mutations and IHC labeling were assessed between invasive and noninvasive components in 1 lesion of 22 independent patients.
    Results: KRAS/GNAS mutation status of invasive and noninvasive components in Inv-IPMN was consistent in 18 (86&#37;) of 21 patients. Conversely, mutational patterns in IPMN and distinct PDAC in the same pancreas differed from each other in 17 (89&#37;) of 19. There were 10 (53&#37;) and 8 (42&#37;) of 19 patients who showed the same p53 and p16/CDKN2A staining between concomitant PDAC and distinct IPMN. In the Inv-IPMN cohort, 19 (86&#37;) of 22 patients showed the same IHC expression pattern between the noninvasive and invasive components.
    Conclusions: It may be possible to distinguish Inv-IPMN from concomitant PDAC by assessing these molecular biomarkers. More precise distinction of Inv-IPMN and concomitant PDAC will lead to adequate recognition of the natural history of IPMNs and hence optimal management.

    DOI: 10.1097/MPA.0000000000000563

  • Predictive Factors for the Metachronous Development of High-risk Lesions in the Remnant Pancreas After Partial Pancreatectomy for Intraductal Papillary Mucinous Neoplasm Reviewed

    Yoshihiro Miyasaka, Takao Ohtsuka, Koji Tamura, Yasuhisa Mori, Koji Shindo, Daisuke Yamada, Shunichi Takahata, Kousei Ishigami, Tetsuhide Ito, Shoji Tokunaga, Yoshinao Oda, Kazuhiro Mizumoto, Masafumi Nakamura, Masao Tanaka

    ANNALS OF SURGERY   263 ( 6 )   1180 - 1187   2016.6

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    Objective: To identify factors predicting the development of high-risk lesions in the remnant pancreas after surgery for intraductal papillary mucinous neoplasm (IPMN).
    Background: IPMN has unique features, including multifocality, adenoma-carcinoma sequence, and the development of distinct pancreatic ductal adenocarcinoma (PDAC) in the same pancreas. Careful attention should, therefore, be paid to the metachronous occurrence of high-risk lesions, including high-grade dysplasia or invasive carcinoma (HGD/INV) of IPMN and concomitant PDAC in the remnant pancreas after partial pancreatectomy for IPMN.
    Methods: Clinicopathologic and surveillance data for 195 patients who underwent partial pancreatectomy for IPMN were reviewed retrospectively.
    Results: Thirteen patients exhibited metachronous development of high-risk lesions including 6 HGD/INV and 7 concomitant PDACs in the remnant pancreas. The 5- and 10-year cumulative incidences of metachronous high-risk lesions in the remnant pancreas were 7.8&#37; and 11.8&#37;, respectively. Twelve of 13 patients had high-risk lesions at the time of initial surgery, and 10 of the 13 IPMNs were located in the distal pancreas. The IPMN subtypes initially resected were gastric in 6 patients, intestinal in 5, and pancreatobililary in the remaining 2. Univariate and multiple regression analyses identified pathologic results of HGD/INV and IPMN located in the distal pancreas as independent predictive factors for metachronous HGD/INV of IPMN, and the pancreatobiliary subtype of IPMN and presence of concomitant PDAC for metachronous PDAC.
    Conclusions: Patients undergoing partial pancreatectomy for IPMN are at high risk of developing lesions requiring surgery in the remnant pancreas, and close, long-term surveillance should be considered in these patients.

    DOI: 10.1097/SLA.0000000000001368

  • Heterogeneity of non-cancerous liver parenchyma on gadoxetic acid-enhanced MRI: an imaging biomarker for hepatocellular carcinoma development in chronic liver disease Reviewed

    Y. Asayama, A. Nishie, K. Ishigami, Y. Ushijima, Y. Takayama, D. Okamoto, N. Fujita, K. Morita, M. Obara, H. Honda

    CLINICAL RADIOLOGY   71 ( 5 )   432 - 437   2016.5

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    AIM: To clarify whether the heterogeneity of non-cancerous liver parenchyma (NLP) in the hepatobiliary phase on gadoxetic acid enhanced magnetic resonance imaging (MRI) is correlated with hepatocellular carcinoma (HCC) development.
    MATERIALS AND METHODS: Institutional review board approval was obtained, and the requirements for informed consent were waived for this retrospective study. The imaging characteristics of 84 patients with chronic liver disease who underwent gadoxetic acid-enhanced 3T MRI between January 2013 and October 2014 were examined retrospectively. For the evaluation of the heterogeneity of the intensity in the hepatobiliary phase, the largest possible region of interest was placed on the NLP, and the skewness and kurtosis were calculated using ImageJ software. Skewness is the degree of asymmetry of a histogram, and kurtosis is a measure of the peak. Based on the median values of kurtosis and skewness, the patients were classified into four categories and the categories were compared between the 49 patients with HCC (HCC group) and the 35 patients without HCC (non-HCC group).
    RESULTS: Kurtosis was significantly higher in the HCC group compared to the non-HCC group (1.19 +/- 1.15 versus 0.43 +/- 0.83; p = 0.0006). Skewness was significantly lower in the HCC group than in the non-HCC group (1.19 +/- 1.15 versus 0.43 +/- 0.83; p = 0.0152). In a multivariate logistic analysis, the category showing lower-than-the-median (-0.1185) skewness and higher-than-the-median (0.547) kurtosis was significantly and independently associated with HCC development (p = 0.0031).
    CONCLUSION: The heterogeneity of NLP in the hepatobiliary phase on gadoxetic acid enhanced MRI may reflect the development of HCC. (C) 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

    DOI: 10.1016/j.crad.2016.01.023

  • Hemodynamic changes under balloon occlusion of hepatic artery: predictor of the short-term therapeutic effect of balloon-occluded transcatheter arterial chemolipiodolization using miriplatin for hepatocellular carcinoma Reviewed

    Yoshiki Asayama, Akihiro Nishie, Kousei Ishigami, Yasuhiro Ushijima, Yukihisa Takayama, Daisuke Okamoto, Nobuhiro Fujita, Koichiro Morita, Hiroshi Honda

    SPRINGERPLUS   5   157   2016.2

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    To clarify the hemodynamic changes under balloon occlusion of the hepatic artery and to identify predictors of the short-term therapeutic effect (TE) after balloon-occluded transcatheter arterial chemoembolization using miriplatin (B-TACE) for hepatocellular carcinoma (HCC). Tumor variables and angiographic data were collected for 35 nodules (29 patients) with a B-TACE for HCC. Lesions were classified into three groups based on the balloon-occluded CT hepatic arteriography (BO-CTHA) results: Group A, presence of corona enhancement; Group B, absence of corona enhancement; Group C, decreased perfusion or perfusion defect compared to standard CTHA. Objective response was defined as TE3/4, and poor TE as TE1/2, evaluated by response evaluation criteria in cancer of the liver at 1-4 months after the procedure. Univariate analysis revealed that proximal level of balloon occlusion, intratumoral lower CT values immediately after treatment and BO-CTHA findings were significantly correlated with poor TE (p = 0.034, 0.037, and 0.003, respectively). Multivariate logistic analysis identified the Group C as a significant factor associated with the worse short term TE (odds ratio 8.34; 95 &#37; confidence interval 1.49-68.8). Partial or complete perfusion defect on BO-CTHA was an independent factor associated with poor therapeutic effect.

    DOI: 10.1186/s40064-016-1880-7

  • Apparent diffusion coefficient: An associative factor for recurrence after nephrectomy in localized renal cell carcinoma Reviewed

    Akihiro Nishie, Daisuke Kakihara, Yoshiki Asayama, Kousei Ishigami, Yasuhiro Ushijima, Yukihisa Takayama, Daisuke Okamoto, Nobuhiro Fujita, Koichiro Morita, Yuichiro Kubo, Junichi Inokuchi, Hiroshi Honda

    JOURNAL OF MAGNETIC RESONANCE IMAGING   43 ( 1 )   166 - 172   2016.1

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    PurposeTo investigate whether the apparent diffusion coefficient (ADC) of a tumor is associated with recurrence after nephrectomy in renal cell carcinoma (RCC)
    Materials and MethodsWe retrospectively studied 49 patients with localized RCC who underwent 1.5T magnetic resonance imaging (MRI) including diffusion-weighted imaging preoperatively. Fifteen patients had recurrent disease after surgery. The ADC was measured by placing a region-of-interest in a solid region of each tumor on the ADC map. We named the average value of the three ADC values the average ADC and the lowest ADC value among the three as the minimum ADC. The correlations between clinicopathological factors including patient age and gender, tumor side, tumor size, growth/invasion pattern, Fuhrman grade, histological subtype, venous invasion, average and minimum ADCs, and disease-free survival were analyzed by Cox proportional hazards model.
    ResultsIn univariate analysis, tumor size, venous invasion, mean ADC, and minimum ADC showed significant correlations with disease-free survival (P < 0.05). In multivariate analysis, only venous invasion and minimum ADC were significant (P < 0.05). The 5-year disease-free survival rate of the low minimum ADC group was 51.6&#37;, while that of the high minimum ADC group was 85.1&#37;.
    ConclusionThe minimum ADC of a tumor, although not as pronounced as venous invasion, was found to be an independent associative factor for recurrence after nephrectomy in patients with localized RCC.

    DOI: 10.1002/jmri.24984

  • Balanced MR cholangiopancreatography with motion-sensitized driven-equilibrium (MSDE) preparation: Feasibility and optimization of imaging parameters Reviewed

    Tomohiro Nakayama, Akihiro Nishie, Takashi Yoshiura, Yoshiki Asayama, Kousei Ishigami, Daisuke Kakihara, Makoto Obara, Hiroshi Honda

    MAGNETIC RESONANCE IMAGING   33 ( 10 )   1219 - 1223   2015.12

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    Purpose: To show the feasibility of motion-sensitized driven-equilibrium-balanced magnetic resonance cholangiopancreatography and to determine the optimal velocity encoding (VENC) value.
    Materials and methods: Sixteen healthy volunteers underwent MRI study using a 1.5-T clinical unit and a 32-channel body array coil. For each volunteer, images were obtained using the following seven respiratory-triggered sequences: (1) balanced magnetic resonance cholangiopancreatography without motion-sensitized driven-equilibrium, and (2)-(7) balanced magnetic resonance cholangiopancreatography with motion-sensitized driven-equilibrium, with VENC = 1, 3, 5, 7, 9 and infinity cm/s for the x-, y-, and z-directions, respectively. Quantitative evaluation was obtained by measuring the maximum signal intensity of the common hepatic duct, portal vein, liver tissue including visible peripheral vessels, and liver tissue excluding visible peripheral vessels that were evaluated. We compared the contrast ratios of portal vein/common hepatic duct, liver tissue including visible peripheral vessels/common hepatic duct and liver tissue excluding visible peripheral vessels/common hepatic duct among the five finite sequences (VENC = 1, 3, 5, 7, and 9 cm/s). Statistical comparisons were performed using the t-test for paired data with the Bonferroni correction.
    Results: Suppression of blood vessel signals was achieved with motion-sensitized driven-equilibrium sequences. We found the optimal VENC values to be either 3 or 5 cm/s with the best suppression of relative vessel signals to bile ducts. At a lower VENC value (1 cm/s), the bile duct signal was reduced, presumably due to minimal biliary flow.
    Conclusion: The feasibility of motion-sensitized driven-equilibrium-balanced magnetic resonance cholangiopancreatography was suggested. The optimal VENC value was considered to be either 3 or 5 cm/s. The clinical usefulness of this new magnetic resonance cholangiopancreatography sequence needs to be verified by further studies. (C) 2015 Elsevier Inc. All rights reserved.

    DOI: 10.1016/j.mri.2015.07.003

  • Shedding light on inflammatory pseudotumor in children: spotlight on inflammatory myofibroblastic tumor Reviewed

    Lillian M. Lai, M. Beth McCarville, Patricia Kirby, Simon C. S. Kao, Toshio Moritani, Eve Clark, Kousei Ishigami, Armita Bahrami, Yutaka Sato

    PEDIATRIC RADIOLOGY   45 ( 12 )   1738 - 1752   2015.11

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    Inflammatory pseudotumor is a generic term used to designate a heterogeneous group of inflammatory mass-forming lesions histologically characterized by myofibroblastic proliferation with chronic inflammatory infiltrate. Inflammatory pseudotumor is multifactorial in etiology and generally benign, but it is often mistaken for malignancy given its aggressive appearance. It can occur throughout the body and is seen in all age groups. Inflammatory pseudotumor has been described in the literature by many organ-specific names, resulting in confusion. Recently within this generic category of inflammatory pseudotumor, inflammatory myofibroblastic tumor has emerged as a distinct entity and is now recognized as a fibroblastic/myofibroblastic neoplasm with intermediate biological potential and occurring mostly in children. We present interesting pediatric cases of inflammatory myofibroblastic tumors given this entity's tendency to occur in children. Familiarity and knowledge of the imaging features of inflammatory pseudotumor can help in making an accurate diagnosis, thereby avoiding unnecessary radical surgery.

    DOI: 10.1007/s00247-015-3360-6

  • Distinguishing intrahepatic cholangiocarcinoma from poorly differentiated hepatocellular carcinoma using precontrast and gadoxetic acid-enhanced MRI Reviewed

    Yoshiki Asayama, Akihiro Nishie, Kousei Ishigami, Yasuhiro Ushijima, Yukihisa Takayama, Nobuhiro Fujita, Yuichiro Kubo, Shinichi Aishima, Ken Shirabe, Takashi Yoshiura, Hiroshi Honda

    DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY   21 ( 2 )   96 - 104   2015.3

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    PURPOSE
    We aimed to gain further insight in magnetic resonance imaging characteristics of mass-forming intrahepatic cholangiocarcinoma (mICC), its enhancement pattern with gadoxetic acid contrast agent, and distinction from poorly differentiated hepatocellular carcinoma (pHCC).
    METHODS
    Fourteen mICC and 22 pHCC nodules were included in this study. Two observers recorded the tumor shape, intratumoral hemorrhage, fat on chemical shift imaging, signal intensity at the center of the tumor on T2-weighted image, fibrous capsule, enhancement pattern on arterial phase of dynamic study, late enhancement three minutes after contrast injection (dynamic late phase), contrast uptake on hepatobiliary phase, apparent diffusion coefficient, vascular invasion, and intrahepatic metastasis.
    RESULTS
    Late enhancement was more common in mICC (n=10, 71&#37;) than in pHCC (n=3, 14&#37;) (P < 0.001). A fat component was observed in 11 pHCC cases (50&#37;) versus none of mICC cases (P = 0.002). Fibrous capsule was observed in 13 pHCC cases (59&#37;) versus none of mICC cases (P < 0.001). On T2-weighted images a hypointense area was seen at the center of the tumor in 43&#37; of mICC (6/14) and 9&#37; of pHCC (2/22) cases (P = 0.018). Other parameters were not significantly different between the two types of nodules.
    CONCLUSION
    The absence of fat and fibrous capsule, and presence of enhancement at three minutes appear to be most characteristic for mICC and may help its differentiation from pHCC.

    DOI: 10.5152/dir.2014.13013

  • Imaging spectrum of renal oncocytomas: a pictorial review with pathologic correlation. Reviewed

    Ishigami K, Jones AR, Dahmoush L, Leite LV, Pakalniskis MG, Barloon TJ

    Insights into imaging   6 ( 1 )   53 - 64   2015.2

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    Imaging spectrum of renal oncocytomas: a pictorial review with pathologic correlation.

    DOI: 10.1007/s13244-014-0373-x

  • Characterization of renal cell carcinoma, oncocytoma, and lipid-poor angiomyolipoma by unenhanced, nephrographic, and delayed phase contrast-enhanced computed tomography Reviewed

    Kousei Ishigami, Marius G. Pakalniskis, Leandro V. Leite, Daniel K. Lee, Danniele G. Holanda, Maheen Rajput

    CLINICAL IMAGING   39 ( 1 )   76 - 84   2015.1

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    The purpose of this study was to assess the characterization of renal cell carcinoma (RCC) and benign renal tumors by unenhanced, nephrographic, and delayed phase computed tomography (CT). The study group consisted of 129 renal tumors including 79 clear cell RCCs, 17 papillary RCCs, 6 chromophobe RCCs, 21 oncocytoma, and 6 lipid-poor angiomyolipomas (AMLs). CT studies were retrospectively reviewed. Our results suggested that it was possible to discriminate clear cell RCC from papillary RCC, chromophobe RCC, and lipid-poor AML CT findings of oncocytoma overlapped with both clear cell and non-clear cell RCCs, although oncocytoma more commonly became homogeneous in the delayed phase. (C) 2015 Elsevier Inc. All rights reserved.

    DOI: 10.1016/j.clinimag.2014.09.008

  • Tumor grade of clear cell renal cell carcinoma assessed by contrast-enhanced computed tomography Reviewed

    Kousei Ishigami, Leandro V. Leite, Marius G. Pakalniskis, Daniel K. Lee, Danniele G. Holanda, David M. Kuehn

    SPRINGERPLUS   3   694   2014.11

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    The purpose of this study was to clarify the association between CT findings and Fuhrman grade of clear cell renal cell carcinoma (ccRCC). The study group consisted of 214 surgically proven ccRCC in 214 patients. Contrast-enhanced CT studies were retrospectively assessed for tumor size, cystic versus solid, calcification, heterogeneity of lesions, percentage of non-enhancing (necrotic) areas, and growth pattern. CT findings and Fuhrman grade were compared. Nineteen of 22 (86.4&#37;) cystic ccRCC were low grade (Fuhrman grades 1-2). There was no significant correlation between tumor size and grade in cystic ccRCC (P = 0.43). In predominantly solid ccRCC, there was significant correlation between tumor size and grade (P < 0.0001). Thirty-eight of 43 (88.4&#37;) infiltrative ccRCC were high grade (Fuhrman grades 3-4). Logistic regression showed tumor size and infiltrative growth were significantly associated with grades 3-4 (P = 0.00083 and P = 0.0059). Cystic ccRCC tends to be low grade. Infiltrative growth and larger tumor size may increase the likelihood of high grade ccRCC.

    DOI: 10.1186/2193-1801-3-694

  • Performance of Gadoxetic Acid-Enhanced MRI for Detecting Hepatocellular Carcinoma in Recipients of Living-Related-Liver-Transplantation: Comparison With Dynamic Multidetector Row Computed Tomography and Angiography-Assisted Computed Tomography Reviewed

    Daisuke Kakihara, Akihiro Nishie, Noboru Harada, Ken Shirabe, Tsuyoshi Tajima, Yoshiki Asayama, Kousei Ishigami, Tomohiro Nakayama, Yukihisa Takayama, Daisuke Okamoto, Nobuhiro Fujita, Junji Kishimoto, Hiroshi Honda

    JOURNAL OF MAGNETIC RESONANCE IMAGING   40 ( 5 )   1112 - 1120   2014.11

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    Purpose: To clarify the diagnostic performance of gadoxetic acid-enhanced MRI for the detection of hepatocellular carcinoma (HCC) in recipients of living related-liver transplantation (LRLT).
    Materials and Methods: This retrospective study group consisted of 15 patients with 61 HCCs who each underwent multidetector row computed tomography (MDCT), gadoxetic acid-enhanced MRI, and angiography-assisted computed tomography (CT) before LRLT. The three modalities were compared for their ability to detect HCC. Two blinded readers independently reviewed the images obtained by each modality for the presence of HCC on a segment-by-segment basis using a 5-point confidence scale. The diagnostic performance of the modalities was evaluated in a receiver operating characteristic (ROC) analysis. The area under the ROC curve (Az), sensitivity, specificity, and accuracy were compared for the three modalities.
    Results: No significant difference in Az, sensitivity, specificity, or accuracy was obtained among gadoxetic acid-enhanced MRI, MDCT, and angiography-assisted CT for both readers. For reader 1, the sensitivity (55.6&#37;) and the accuracy (84.7&#37;) of angiography-assisted CT were significantly higher than those of MDCT (33.3&#37; and 78.0&#37;) (P < 0.05).
    Conclusion: Gadoxetic acid-enhanced MRI has a relatively high diagnostic ability to detect HCC even in recipients of LRLT, equivalent to the abilities of MDCT and angiography-assisted CT.

    DOI: 10.1002/jmri.24454

  • [Cryoablation for renal cell carcinoma - minimally invasive therapy under image guidance]. Reviewed

    Ushijima Y, Asayama Y, Nishie A, Okamoto D, Morita K, Ishigami K, Takayama Y, Fujita N, Yokomizo A, Naito S, Honda H

    Fukuoka igaku zasshi = Hukuoka acta medica   105 ( 10 )   191 - 195   2014.10

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    [Cryoablation for renal cell carcinoma - minimally invasive therapy under image guidance].

    DOI: 10.15017/1477814

  • Pathological manifestation of difference in washout pattern of adrenal hyperplasia on dynamic CT Reviewed

    Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Daisuke Kakihara, Tomohiro Nakayama, Yasuhiro Ushijima, Yukihisa Takayama, Akira Yokomizo, Katsunori Tatsugami, Junichi Inokuchi, Nobuhiro Fujita, Yuichiro Kubo, Shinichi Aishima, Masakazu Hirakawa, Hiroshi Honda

    JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY   58 ( 5 )   559 - 564   2014.10

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    Introduction: The relationship between the washout pattern and constituent cell in adrenal hyperplasia (AH) has not been fully investigated. The purpose of this study was to elucidate the radiological or pathological factors determining the washout pattern of AH on dynamic CT.
    Methods: Ten patients with 14 surgically proven AHs were enrolled. Dynamic CT was scanned before (pre-contrast image) and 60 seconds (early phase) and 240 seconds (delayed phase) after administration of iodine contrast. The absolute percentage washout (APW) of each nodular lesion was calculated using the following formula: APW(&#37;) = (TAearly-TAdelay)/(TAearly-TApre) x 100, when TApre, TAearly and TAdelay were defined as tumour attenuation values of pre-contrast, early and delayed phases, respectively. Pathologically, the clear cell ratio (CCR) constituting each nodular lesion was qualitatively assessed. Regression analysis was performed to evaluate a correlation between each pair of CCR, TApre, (TAearly-TAdelay) and APW.
    Results: There was a significant correlation between each pair of CCR, TApre and APW. CCR decreased as TApre increased (r = 0.81, P < 0.001). APW increased as CCR decreased (r = 0.80, P < 0.001) or as TApre increased (r = 0.74, P < 0.01).
    Conclusions: The key factors of washout pattern of AH on dynamic CT were CCR and TApre. The difference in constituent cell was associated with variability in APW of AH.

    DOI: 10.1111/1754-9485.12211

  • The Apelin-APJ System Induces Tumor Arteriogenesis in Hepatocellular Carcinoma Reviewed

    Jun Muto, Ken Shirabe, Tomoharu Yoshizumi, Toru Ikegami, Shinichi Aishima, Kousei Ishigami, Yoshikazu Yonemitsu, Tetsuo Ikeda, Yuji Soejima, Yoshihiko Maehara

    ANTICANCER RESEARCH   34 ( 10 )   5313 - 5320   2014.10

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    Aim: The apelin-APJ system regulates angiogenesis, and is overexpressed in several types of cancer. The aim of this study was to clarifY the role of the apelin-APJ system in the angiogenesis of hepatocellular carcinoma (HCC). Materials and Methods: Expressions of angiogenic factors and vascular markers were investigated in specimens from 90 HCC patients. A subcutaneous HCC tumor mouse model was treated with the APJ antagonist, F13A, and tumor growth and vascular development were assessed. Results: API expression was observed in arteriole-smooth muscle. Higher amounts of APJ(+) - arteriole and ape/in were detected in tumors (p<0.001 for both). APJ(+)-arteriole and ape/in expression were more commonly observed in moderately- and poorly-differentiated than in well-differentiated HCC (p <= 0.003). HCC with irregular dilated arteries expressed higher levels of ape/in (p=0.012), Tumor growth was inhibited by treatment with Fl 3A (p<0,001), and arterioles were decreased in the treated group (p=0.047), in vivo. Conclusion: Ape/in-API is overexpressed, and works as a signal for arterio genesis in HCC

  • Efficacy of preoperative transcatheter arterial chemoembolization combined with systemic chemotherapy for treatment of unresectable hepatoblastoma in children Reviewed

    Masakazu Hirakawa, Akihiro Nishie, Yoshiki Asayama, Nobuhiro Fujita, Kousei Ishigami, Tatsurou Tajiri, Tomoaki Taguchi, Hiroshi Honda

    JAPANESE JOURNAL OF RADIOLOGY   32 ( 9 )   529 - 536   2014.9

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    The purpose of this study was to evaluate, retrospectively, the clinical efficacy of preoperative transcatheter arterial chemoembolization (TACE) combined with systemic chemotherapy for unresectable hepatoblastoma.
    Five boys and three girls (mean age 15.2 months) were treated with preoperative TACE combined with systemic chemotherapy for unresectable hepatoblastomas. Mean tumor diameter and mean alfa-fetoprotein (AFP) level were 11.8 cm and 549,386 ng/mL, respectively. Pretreatment, the extent of disease (PRETEXT) was: II, 1; III, 6; IV, 1. For all patients, preoperative systemic chemotherapy was administered before TACE. At each TACE, carboplatin and adriamycin mixed with iodized oil were infused into the feeding arteries. Tumor response and prognosis after treatment were evaluated.
    TACE resulted in few Grade 1 adverse effects (AEs), without G3 or more AEs, according to CTACAE 3.0. Mean tumor shrinkage was 60.9 &#37;, and the mean AFP decrease from initial levels was 94.8 &#37;. In all cases TACE combined with systemic chemotherapy enabled subsequent safe and complete surgical resection. After a mean follow-up of 59 months, tumor-free survival was 75 &#37;.
    Preoperative TACE combined with systemic chemotherapy was effective in inducing surgical resectability of unresectable hepatoblastoma.

    DOI: 10.1007/s11604-014-0340-y

  • Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MR finding of radiation-induced hepatic injury: Relationship to absorbed dose and time course after irradiation Reviewed

    Daisuke Okamoto, Akihiro Nishie, Yoshiki Asayama, Tsuyoshi Tajima, Kousei Ishigami, Daisuke Kakihara, Tomohiro Nakayama, Saiji Ohga, Tadamasa Yoshitake, Yoshiyuki Shioyama, Hiroshi Honda

    MAGNETIC RESONANCE IMAGING   32 ( 6 )   660 - 664   2014.7

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    Purpose: To evaluate if Gd-EOB-DTPA-enhanced MRI could identify liver tissue damage caused by radiation exposure in patients undergoing external beam radiation therapy.
    Materials and methods: We enrolled 11 patients who underwent Gd-EOB-DTPA-enhanced MRI during or after radiotherapy in which the radiation field included the liver. External beam radiotherapy was delivered through multiple fields using a 10-MV linear accelerator. The hepatobiliary phase images of Gd-EOB-DTPA-enhanced MRI were qualitatively evaluated for the presence of a decreased uptake of Gd-EOB-DTPA in the irradiated area in the liver. Next, signal intensity (SI) ratio of the irradiated area to the non-irradiated liver parenchyma was also calculated. The absorbed dose of the irradiated area in the liver was standardized using equivalent dose in 2 Gy fraction (EQD2) and biological effective dose (BED). The results of qualitative analysis were compared with EQD2 or BED, and linear regression analysis was performed between EQD2 or BED and SI ratio.
    Results: Twenty-two irradiated areas were evaluated. Qualitative analysis revealed a decreased uptake of Gd-EOB-DTPA in 14 areas and no decreased uptake of Gd-EOB-DTPA in eight areas. The thresholds of EQD2 and BED causing a decreased uptake of Gd-EOB-DTPA were considered to be 24 to 29 Gy and 29 to 35 Gy, respectively. Quantitatively, SI ratio decreased as EQD2 or BED increased (r = 0.89, p < 0.001), and the inverse relationship between signal enhancement and the absorbed dose in the irradiated area was obtained. One area with EQD2 of 50 Gy and BED of 60Gy showed a slightly decreased uptake of Gd-EOB-DTPA on the 40th day but a clearly decreased uptake of Gd-EOB-DTPA on the 123rd day from initiation of radiotherapy.
    Conclusions: Gd-EOB-DTPA-enhanced MRI described RLI as a decreased uptake of Gd-EOB-DTPA matching the irradiated area. The occurrence of this finding was significantly correlated with the absorbed dose of the irradiated area in the liver. (C) 2014 Elsevier Inc. All rights reserved.

    DOI: 10.1016/j.mri.2014.02.019

  • Role of tumor-associated macrophages in the angiogenesis of well-differentiated hepatocellular carcinoma: Pathological-radiological correlation Reviewed

    Nobuhiro Fujita, Akihiro Nishie, Shinichi Aishima, Yuichiro Kubo, Yoshiki Asayama, Kousei Ishigami, Daisuke Kakihara, Yasuhiro Ushijima, Yukihisa Takayama, Ken Shirabe, Yoshinao Oda, Hiroshi Honda

    ONCOLOGY REPORTS   31 ( 6 )   2499 - 2505   2014.6

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    The role of tumor-associated macrophages (TAMs) in hepatocellular carcinoma (HCC) has not been fully investigated. The aim of the present study was to clarify whether TAMs are associated with the angiogenesis of HCC during its multistep development, especially at an early stage. Forty-three well-differentiated HCCs and 30 well- to moderately differentiated HCCs (nodule-in-nodule lesion) were used. We immunohistochemically assessed microvessel density (by CD34) and macrophage count (by CD68 or CD163). Computed tomography hepatic angiography (CTHA) was performed for 26 well-differentiated HCCs and all 30 well- to moderately differentiated HCCs. The pathological analysis of the 43 well-differentiated HCCs revealed a positive correlation between microvessel density and macrophage count (P=0.0026, r=0.4486). Based on the CTHA findings, 26 well-differentiated HCCs classified into a hyperattenuation group (n=14) and a hypo- or isoattenuation group (n=12). The microvessel density and macrophage count of the hyperattenuation group were significantly higher than those of the hypo- or isoattenuation group (P=0.0372 and P=0.0476). In the 30 well- to moderately differentiated HCCs, microvessel density of the moderately differentiated components was significantly higher than that of the well-differentiated components (P<0.0001). However, the macrophage count of the moderately differentiated component was significantly lower than that of the well-differentiated component (P<0.0001). All the moderately differentiated components showed marked hyperattenuation on CTHA. Tumor vascularity was correlated with macrophage count in the tumor when limited to well-differentiated HCCs. TAMs may have a role in promoting angiogenesis of HCC at an early stage during its multistep development.

    DOI: 10.3892/or.2014.3138

  • Comparison of 2 Oral Ultrasonography Contrast Agents Simethicone-Coated Cellulose and Simethicone-Water Rotation in Improving Pancreatic Visualization Reviewed

    Kousei Ishigami, Dina M. Abu-Yousef, Simon C. S. Kao, Monzer M. Abu-Yousef

    ULTRASOUND QUARTERLY   30 ( 2 )   135 - 138   2014.6

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    Purpose: The purpose of this study was to prospectively compare the efficacy of 2 oral ultrasonography (US) contrast agents (simethicone-water rotation [SWR] and simethicone-coated cellulose [SCC]) in improving visualization of the pancreas.
    Methods: Two sessions (SWR and SCC) of transabdominal US studies were performed on 38 healthy volunteers. In each session, US images were obtained in precontrast supine and upright positions and postcontrast supine and upright positions. The visualization of the pancreas was graded on a scale of 1 to 5 (1 = nonvisualization, 5 = excellent visualization), grading the head, body, and tail separately.
    Results: In the supine position, SWR significantly improved the visualization of the pancreatic head, body, and tail, whereas there were no significant differences between SCC and precontrast images. Simethicone-water rotation showed significantly better visualization than SCC. The average scores of the head, body, and tail of the pancreas that graded 4 or more were 15.8&#37; of precontrast, 21.1&#37; of SCC, and 50&#37; of SWR. In the upright position, both SWR and SCC significantly improved the visualization of the pancreas, except for the pancreatic body on SCC. There were no significant differences between SWR and SCC. The average scores that graded 4 or more were 26.3&#37; of precontrast, 57.9&#37; of SCC, and 65.8&#37; of SWR.
    Conclusion: Simethicone-water rotation was more effective than SCC in improving the visualization of the pancreas.

    DOI: 10.1097/RUQ.0000000000000052

  • Radiologic manifestations of angioedema. Reviewed

    Ishigami K, Averill SL, Pollard JH, McDonald JM, Sato Y

    Insights into imaging   5 ( 3 )   365 - 374   2014.6

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    Radiologic manifestations of angioedema.

    DOI: 10.1007/s13244-014-0329-1

  • Imaging pitfalls of pancreatic serous cystic neoplasm and its potential mimickers. Reviewed International journal

    Ishigami K, Nishie A, Asayama Y, Ushijima Y, Takayama Y, Fujita N, Takahata S, Ohtsuka T, Ito T, Igarashi H, Ikari S, Metz CM, Honda H

    World journal of radiology   6 ( 3 )   36 - 47   2014.3

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    Imaging pitfalls of pancreatic serous cystic neoplasm and its potential mimickers.
    The aim of this article is to clarify diagnostic pitfalls of pancreatic serous cystic neoplasm (SCN) that may result in erroneous characterization. Usual and unusual imaging findings of SCN as well as potential SCN mimickers are presented. The diagnostic key of SCN is to look for a cluster of microcysts (honeycomb pattern), which may not be always found in the center. Fibrosis in SCN may be mistaken for a mural nodule of intraductal papillary mucinous neoplasm (IPMN). The absence of cyst wall enhancement may be helpful to distinguish SCN from mucinous cystic neoplasm. However, oligocystic SCN and branch duct type IPMN may morphologically overlap. In addition, solid serous adenoma, an extremely rare variant of SCN, is difficult to distinguish from neuroendocrine tumor.

    DOI: 10.4329/wjr.v6.i3.36

  • Clinicopathological significance of the peritumoral decreased uptake area of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid in hepatocellular carcinoma Reviewed

    Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Daisuke Kakihara, Tomohiro Nakayama, Yasuhiro Ushijima, Yukihisa Takayama, Ken Shirabe, Nobuhiro Fujita, Yuichiro Kubo, Masakazu Hirakawa, Hiroshi Honda

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   29 ( 3 )   561 - 567   2014.3

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    Background and AimA faint hypointensity in the noncancerous tissue around hepatocellular carcinoma (HCC) in the hepatobiliary phase of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) is encountered. The goal is to elucidate the significance of this type of pseudolesion designated as the peritumoral decreased uptake area of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) (PDUAE).
    MethodsThis study group consisted of 61 patients with 61 surgically resected HCCs who underwent preoperative Gd-EOB-DTPA-enhanced MRI. The presence of a faint and hypointense area around the tumor in the hepatobiliary phase was defined as PDUAE. The frequency with which PDUAE was seen was compared between pairs of groups determined by clinical and pathological parameters using a Fisher's exact probability test. The parameters showing significant differences in this test were further tested by multiple logistic regression analysis.
    ResultsPDUAE was observed in 25 cases. In univariate analysis, the values of alpha-fetoprotein and protein-induced by vitamin K absence or antagonist-II, maximal diameter, the presence of a capsule, and vascular invasion were significantly correlated with the frequency with which PDUAE was seen. In multivariate analysis, only maximal diameter and vascular invasion were significantly correlated. When the presence of PDUAE was used as an indicator of vascular invasion, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 72&#37;, 80.6&#37;, 77&#37;, 72&#37;, and 80.6&#37;, respectively.
    ConclusionsBy using this indicator, microscopic vascular invasion of HCC can be easily predicted with Gd-EOB-DTPA-enhanced MRI.

    DOI: 10.1111/jgh.12423

  • Intraductal Papillary Mucinous Neoplasms of the Pancreas With Distinct Pancreatic Ductal Adenocarcinomas Are Frequently of Gastric Subtype Reviewed

    Noboru Ideno, Takao Ohtsuka, Hiroshi Kono, Kenji Fujiwara, Yasunori Oda, Shinichi Aishima, Tetsuhide Ito, Kousei Ishigami, Shoji Tokunaga, Kenoki Ohuchida, Shunichi Takahata, Masafumi Nakamura, Kazuhiro Mizumoto, Masao Tanaka

    ANNALS OF SURGERY   258 ( 1 )   141 - 151   2013.7

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    Objective: To identify a high-risk group of patients with pancreatic ductal adenocarcinoma (PDAC), independently arising in the pancreas with intraductal papillary mucinous neoplasm (IPMN), using histopathologic subtypes.
    Background: Pathologic features of IPMN with distinct PDAC, including histopathologic subtypes of IPMN and PDAC phenotypes, have not been well characterized. Mucin expression patterns and the mutational status of GNAS and KRAS are useful to explore the relationship between these 2 lesion types.
    Methods: Clinicopathologic data of 179 resected IPMNs and 180 resected PDACs without IPMNs as a control group were reviewed. IPMNs were classified into 4 grades (low-grade, intermediate-grade, high-grade dysplasia, and an associated invasive carcinoma) and 4 subtypes (gastric, intestinal, pancreatobiliary, and oncocytic). The expression of MUC1, MUC2, MUC5AC, MUC6, and CDX2 was investigated by immunohistochemistry in IPMNs and PDACs with and without IPMNs. The mutational status of GNAS and KRAS was evaluated by cycle sequencing in PDACs and pre-/coexisting IPMNs.
    Results: Twenty-six synchronous or metachronous PDACs were identified in 20 patients (11.2&#37;) with IPMNs. Occurrence of concomitant PDACs was more frequently observed in gastric-type IPMNs (18/110, 16.4&#37;) compared with intestinal (1/49, 2.0&#37;), pancreatobiliary (1/17, 5.9&#37;), or oncocytic-type (0/3, 0&#37;) (P = 0.047). Both PDACs with and without IPMNs were frequently positive for MUC1, MUC5AC, and MUC6 expression, as assessed by immunohistochemistry, but were negative for MUC2 and CDX2. The mucin-staining patterns were similar to those of invasive tubular adenocarcinoma arising from gastric-type IPMNs. Mutation of GNAS within codon 201 was not detected in PDACs and gastric-type IPMNs, whereas most of these exhibited KRAS mutations. However, the R201H GNAS mutation was detected in 1 intestinal-type IPMN with distinct PDAC.
    Conclusions: Mucin expression patterns demonstrate that PDAC without GNAS mutations of an aggressive phenotype frequently arise in the pancreas with benign gastric-type IPMN in the absence of GNAS mutations.

    DOI: 10.1097/SLA.0b013e31828cd008

  • Role of endoscopic retrograde pancreatography for early detection of pancreatic ductal adenocarcinoma concomitant with intraductal papillary mucinous neoplasm of the pancreas Reviewed

    Takao Ohtsuka, Noboru Ideno, Teppei Aso, Yosuke Nagayoshi, Hiroshi Kono, Yasuhisa Mori, Shunichi Takahata, Yasunori Oda, Shinichi Aishima, Hisato Igarashi, Tetsuhide Ito, Kousei Ishigami, Masafumi Nakamura, Kazuhiro Mizumoto, Masao Tanaka

    JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES   20 ( 3 )   356 - 361   2013.3

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    Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is often found with distinct pancreatic ductal adenocarcinoma (PDAC) in the same pancreas. The aim of this study was to clarify whether endoscopic retrograde pancreatography (ERP) would be useful for the early detection of concomitant PDACs in patients with IPMNs.
    Medical records of 179 patients who were histologically confirmed to have IPMNs after resection between 1987 and 2011 were reviewed. The patients having concomitant PDACs were selected, and the diagnostic abilities to detect concomitant PDACs of computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS), and ERP were compared between early (stages 0-I according to Japanese General Rules for Pancreatic Cancer) and advanced (stages II-IV) PDACs.
    A total of 23 PDACs developed synchronously or metachronously in 20 patients, and the prevalence of PDACs concomitant with IPMNs was 11.2 &#37; (20/179). Sensitivities of CT (16 vs. 87 &#37;), MRI (29 vs. 93 &#37;), and EUS (29 vs. 92 &#37;) in the early group were significantly lower than those in the advanced group (p < 0.01). On the other hand, the sensitivity of ERP in the early group was as high as that in the advanced group (86 vs. 82 &#37;, respectively, p > 0.99). Among 7 early PDACs, 3 were diagnosed only by ERP.
    ERP has an important role in the early diagnosis of distinct PDACs in patients with IPMNs. Further investigation is necessary to clarify the indication and the timing of ERP during management of IPMNs in term of early detection of concomitant PDACs.

    DOI: 10.1007/s00534-012-0541-7

  • Clinical outcomes of symptomatic arterioportal fistulas after transcatheter arterial embolization. Reviewed International journal

    Hirakawa M, Nishie A, Asayama Y, Ishigami K, Ushijima Y, Fujita N, Honda H

    World journal of radiology   5 ( 2 )   33 - 40   2013.2

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    Clinical outcomes of symptomatic arterioportal fistulas after transcatheter arterial embolization.
    AIM: To evaluate the complications and clinical outcomes of transcatheter arterial embolization (TAE) for symptoms related to severe arterioportal fistulas (APFs). METHODS: Six patients (3 males, 3 females; mean age, 63.8 years; age range, 60-71 years) with chronic liver disease and severe APFs due to percutaneous intrahepatic treatment (n = 5) and portal vein (PV) tumor thrombosis of hepatocellular carcinoma (n = 1) underwent TAE for symptoms related to severe APFs [refractory ascites (n = 4), hemorrhoidal hemorrhage (n = 1), and hepatic encephalopathy (n = 1)]. Control of symptoms related to APFs and complications were evaluated during the follow-up period (range, 4-57 mo). RESULTS: In all patients, celiac angiography revealed immediate retrograde visualization of the main PV before TAE, indicating severe APF. Selective TAE for the hepatic arteries was performed using metallic coils (MC, n = 4) and both MCs and n-butyl cyanoacrylate (n = 2). Three patients underwent repeated TAEs for residual APFs and ascites. Four patients developed PV thrombosis after TAE. During the follow-up period after TAE, APF obliteration and symptomatic improvement were obtained in all patients. CONCLUSION: Although TAE for severe APFs may sometimes be complicated by PV thrombosis, TAE can be an effective treatment to improve clinical symptoms related to severe APFs.

    DOI: 10.4329/wjr.v5.i2.33

  • CT prediction of histological grade of hypervascular hepatocellular carcinoma: Utility of the portal phase Reviewed

    Akihiro Nishie, Kengo Yoshimitsu, Daisuke Okamoto, Tsuyoshi Tajima, Yoshiki Asayama, Kousei Ishigami, Daisuke Kakihara, Tomohiro Nakayama, Yukihisa Takayama, Ken Shirabe, Nobuhiro Fujita, Hiroshi Honda

    Japanese Journal of Radiology   31 ( 2 )   89 - 98   2013.2

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    Purpose: To elucidate whether the attenuation of hypervascular hepatocellular carcinoma (HCC) on the portal phase of dynamic CT is correlated with histological grade. Materials and methods: This study group consisted of 66 patients with 74 surgically resected, hypervascular HCCs. On a preoperative dynamic study with a 64-multidetector row CT, the portal phase was scanned 60 s after injecting the contrast agent following the pre-contrast image and hepatic arterial phase. The tumor attenuation of each HCC on the portal phase was categorized into high, iso-, or low, and was compared with the predominant histological grade using Mann-Whitney's U test. Results: Twenty-nine, 29, and 16 HCCs showed high, iso-, and low attenuation on the portal phase, respectively. Tumors were classified into three well- (w-), 58 moderately (m-), or 13 poorly (p-) differentiated HCCs. The tumor attenuation of p-HCC on the portal phase was significantly lower than those of w-HCC and m-HCC (p &lt
    0.05 and p &lt
    0.00001). Conclusion: The tumor attenuation on the portal phase may help when diagnosing the histological grade of hypervascular HCC. p-HCC are considered to show a faster contrast washout than w-HCC and m-HCC. © 2012 Japan Radiological Society.

    DOI: 10.1007/s11604-012-0149-5

  • Image quality of Gd-EOB-DTPA-enhanced magnetic resonance imaging of the liver using dual-source parallel radiofrequency transmission technology: Comparison with the post-processing correction method for B1 inhomogeneity-induced signal loss Reviewed

    Yukihisa Takayama, Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Daisuke Kakihara, Tomohiro Nakayama, Takashi Yoshiura, Makoto Obara, Masakazu Hirakawa, Hiroshi Honda

    EUROPEAN JOURNAL OF RADIOLOGY   81 ( 11 )   3035 - 3040   2012.11

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    Purpose: To evaluate the efficacy of the dual-source parallel radiofrequency system (DS system) for gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI).
    Materials and methods: Twenty-six subjects with liver diseases underwent hepatobiliary phase imaging of Gd-EOB-MRI using either the DS system or a single-source radiofrequency system with or without body-tuned CLEAR, which is a post-processing correction method of B1 inhomogeneity-induced signal loss (SSBTC+ and SSBTC-, respectively). The left and right lobes of the liver were separately assessed. Qualitatively, the homogeneity of signal intensity distribution was scored using a 3-point scale. Quantitatively, lesion-to-liver and spleen-to-liver contrast ratios (CRs) were calculated. The scores and CRs were compared among the three techniques by two-way analysis of variance and Tukey's Honestly Significant Difference post hoc test. Values of p < 0.05 were considered statistically significant for each analysis.
    Results: The DS system showed a significantly better score in the left lobe of the liver, and higher lesion-to-liver and spleen-to-liver CRs in the left and right lobes of the liver, compared with SSBTC+ or SSBTC- (p < 0.05). The DS system and SSBTC-showed no significant differences in scores in the right lobe of the liver but they showed significantly better scores than SSBTC+ (p < 0.05).
    Conclusion: The DS system is more advantageous to improve the homogeneity of signal intensity distribution and tissue contrast of Gd-EOB-MRI than the post-processing correction method independently of the site. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.ejrad.2012.03.026

  • Hypovascular hepatic nodule showing hypointensity in the hepatobiliary phase of gadoxetic acid-enhanced MRI in patients with chronic liver disease: Prediction of malignant transformation Reviewed

    Yukihisa Takayama, Akihiro Nishie, Tomohiro Nakayama, Yoshiki Asayama, Kousei Ishigami, Daisuke Kakihara, Yasuhiro Ushijima, Nobuhiro Fujita, Masakazu Hirakawa, Hiroshi Honda

    EUROPEAN JOURNAL OF RADIOLOGY   81 ( 11 )   3072 - 3078   2012.11

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    Purpose: To investigate the predictive factors of malignant transformation of hypovascular hepatic nodule showing hypointensity in the hepatobiliary phase images of gadoxetic acid-enhanced MRI (HHN).
    Materials and Methods: The clinical data and imaging findings of dynamic contrast-enhanced computed tomography (DCE-CT) and gadoxetic acid-enhanced MRI for a total of 103 HHNs in 24 patients with chronic liver disease were retrospectively investigated. After the results of follow-up examinations were investigated, HHNs were categorized into the three groups for each comparison: (1) nodules with enlargement and/or vascularization and others, (2) nodules with only enlargement and others, (3) nodules with only vascularization and others. Enlargement and/or vascularization during the follow-up period were defined as malignant transformation of HHN. The frequency of each clinical datum and imaging finding in each group was compared to identify the predictive factors for malignant transformation in HHN.
    Results: Multivariate analysis showed that a nodule size of 9 mm or more on the initial gadoxetic acid-enhanced MRI was a significant predictive factor for the enlargement and/or vascularization of HHN (P < 0.05). On the other hand, the hypoattenuation on the delayed phase imaging of the initial DCE-CT was a significant predictive factor for the enlargement or vascularization of HHN (P < 0.05).
    Conclusion: A nodule size of 9 mm or more on the initial gadoxetic acid-enhanced MRI and hypoattenuation on the delayed phase imaging of initial DCE-CT would be helpful for predicting the outcome of HHN in patients with a risk of hepatocellular carcinoma. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.ejrad.2012.05.008

  • Management Strategy for Multifocal Branch Duct Intraductal Papillary Mucinous Neoplasms of the Pancreas Reviewed

    Yasuhisa Mori, Takao Ohtsuka, Hiroshi Kono, Noboru Ideno, Teppei Aso, Yosuke Nagayoshi, Shunichi Takahata, Masafumi Nakamura, Kousei Ishigami, Shinichi Aishima, Yoshinao Oda, Masao Tanaka

    PANCREAS   41 ( 7 )   1008 - 1012   2012.10

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    Objectives: Branch duct intraductal papillary mucinous neoplasms of the pancreas (BD-IPMNs) often are composed of multifocal lesions. We aimed to clarify the clinicopathologic features of multifocal BD-IPMNs.
    Methods: Medical records of 211 patients with BD-IPMNs (169 solitary and 42 multifocal) were retrospectively analyzed. We compared the pathological grade of resected IPMNs and the resulting clinical course between solitary and multifocal BD-IPMNs.
    Results: Sixty-nine patients (54 with solitary and 15 with multifocal BD-IPMNs) underwent pancreatectomy, and of these patients, 62 exhibited at least 1 malignant predictor. There was no significant difference in the prevalence of malignancy in the resected BD-IPMNs between the 2 groups. In the remaining 142 patients who exhibited no malignant predictors, both groups demonstrated no differences in morphologic changes of BD-IPMNs. Seventeen distinct ductal carcinomas were identified in both groups, and there was no difference in the prevalence of ductal carcinoma between the 2 groups. Moreover, there was no significant difference in the disease-specific survival rate between the 2 groups.
    Conclusions: In patients with multifocal BD-IPMNs, resection is only warranted for lesions that exhibit malignancy predictors; moreover, closer attention to the potential presence or development of distinct ductal carcinoma in patients with multifocal and solitary BD-IPMNs is warranted.

    DOI: 10.1097/MPA.0b013e31824b22c6

  • MR prediction of liver fibrosis using a liver-specific contrast agent: Superparamagnetic iron oxide versus Gd-EOB-DTPA Reviewed

    Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Tsuyoshi Tajima, Daisuke Kakihara, Tomohiro Nakayama, Yukihisa Takayama, Daisuke Okamoto, Akinobu Taketomi, Ken Shirabe, Nobuhiro Fujita, Makoto Obara, Kengo Yoshimitsu, Hiroshi Honda

    JOURNAL OF MAGNETIC RESONANCE IMAGING   36 ( 3 )   664 - 671   2012.9

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    Purpose: To examine whether the uptake of a liver-specific contrast agent in the liver parenchyma was correlated with the degree of liver fibrosis. Materials and Methods: This retrospective study included 54 and 63 patients who underwent superparamagnetic iron oxide (SPIO)- and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI before liver surgery, respectively. For each patient, we calculated ?R2* and ?R2, which represent differences in R2* and R2 values of the liver parenchyma before and after administration of SPIO; and the increase rate of liver-to-spleen signal intensity ratio (LSR) on the hepatobiliary phase compared with the precontrast image. The correlation of each MR parameter with the degree of liver fibrosis (F0 to F4) was assessed using Spearman's rank correlation test. Results: The increase rate of LSR was best correlated with the degree of liver fibrosis and significantly decreased as the liver fibrosis progressed (rho = -0.641; P < 0.0001). It showed sensitivity of 76.9&#37; and specificity of 83.3&#37; in differentiating F3 or greater fibrosis when 1.126 or less was set up as a cut-off value. No significant correlation was obtained between ?R2* or ?R2 and the degree of liver fibrosis. Conclusion: The uptake of Gd-EOB-DTPA in the liver parenchyma decreased as the liver fibrosis progressed. J. Magn. Reson. Imaging 2012;36:664671. (C) 2012 Wiley Periodicals, Inc.

    DOI: 10.1002/jmri.23691

  • Diagnostic significance of a dilated orifice of the duodenal papilla in intraductal papillary mucinous neoplasm of the pancreas Reviewed

    Teppei Aso, Takao Ohtsuka, Noboru Ideno, Hiroshi Kono, Yosuke Nagayoshi, Yasuhisa Mori, Kennoki Ohuchida, Junji Ueda, Shunnichi Takahata, Katsuya Morimatsu, Shinichi Aishima, Hisato Igarashi, Tetsuhide Ito, Kousei Ishigami, Kazuhiro Mizumoto, Masao Tanaka

    GASTROINTESTINAL ENDOSCOPY   76 ( 2 )   313 - 320   2012.8

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    Background: A dilated orifice of the duodenal papilla found during screening endoscopy or ERCP is well-known as one of the specific findings of intraductal papillary mucinous neoplasm (IPMN). However, its clinical significance is still unclear.
    Objective: To assess the diagnostic significance of a dilated orifice of the duodenal papilla and evaluate whether this could be a factor predictive of malignancy or a subtype of IPMN.
    Design: Retrospective study.
    Setting: University hospital.
    Patients: This study involved 149 patients who underwent pancreatectomy for IPMN between January 1987 and June 2011.
    Intervention: ERCP.
    Main Outcome Measurements: The rate of malignant and intestinal type IPMNs in patients with and without papillary dilation.
    Results: A dilated orifice of the duodenal papilla was significantly associated with intestinal type IPMN (P < .001), but this finding could not predict the malignant grade of IPMN (P = .13). Multivariate analysis revealed that a dilated orifice was a significant factor for predicting intestinal type in both main duct (P = .01) and branch duct IPMNs (P < .001).
    Limitations: The validity of the definition of papillary dilation, selection bias, and a retrospective study.
    Conclusion: A dilated orifice of the duodenal papilla could be a significant factor for predicting intestinal type IPMN. This may lead to better clinical management of patients with IPMN. (Gastrointest Endosc 2012;76:313-20.)

    DOI: 10.1016/j.gie.2012.03.682

  • Follow-up study after resection of intraductal papillary mucinous neoplasm of the pancreas; special references to the multifocal lesions and development of ductal carcinoma in the remnant pancreas Reviewed

    Takao Ohtsuka, Hiroshi Kono, Reiko Tanabe, Yosuke Nagayoshi, Yasuhisa Mori, Yoshihiko Sadakari, Shunichi Takahata, Yasunori Oda, Shinichi Aishima, Hisato Igarashi, Tetsuhide Ito, Kousei Ishigami, Masafumi Nakamura, Kazuhiro Mizumoto, Masao Tanaka

    AMERICAN JOURNAL OF SURGERY   204 ( 1 )   44 - 48   2012.7

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    BACKGROUND: Frequency and characteristics of metachronous occurrence of multifocal intraductal papillary mucinous neoplasms (IPMNs) or distinct pancreatic ductal adenocarcinomas (PDACs) in the remnant pancreas during follow-up evaluation after pancreatectomy for IPMNs have not been well known. The aim of this study was to investigate the outcomes after resection of IPMNs, especially focusing on the metachronous occurrence of multifocal IPMNs and distinct PDACs.
    METHODS: Medical records of 172 patients who underwent resection of IPMNs were reviewed retrospectively, and the data regarding the occurrence of metachronous IPMNs or PDACs in the remnant pancreas during a mean postoperative follow-up period of 64 months were collected.
    RESULTS: The incidence including synchronous and metachronous multifocal occurrence of IPMNs was 20&#37; (34 of 172), and that of distinct PDACs was 9.9&#37; (17 of 172). Ten metachronous IPMNs developed in the remnant pancreas after a mean time of 23 postoperative months (range, 12-84 mo), and 2 with main duct IPMNs (both were carcinoma in situ) required remnant pancreatectomy. Six distinct PDACs developed in the remnant pancreas after a mean time of 84 postoperative months (range, 12-150 mo). Four of them were found to have a tumor with a size of less than 2 cm, whereas the remaining 2 PDACs were found to be unresectable more than 10 years after resection of IPMNs.
    CONCLUSIONS: Intense long-term follow-up evaluation is necessary for the early detection of metachronous occurrence of distinct PDACs as well as malignant IPMNs after resection of IPMNs. (C) 2012 Elsevier Inc. All rights reserved.

    DOI: 10.1016/j.amjsurg.2011.04.007

  • Quantitative analysis of liver function using superparamagnetic iron oxide- and Gd-EOB-DTPA-enhanced MRI: Comparison with Technetium-99m galactosyl serum albumin scintigraphy Reviewed

    Akihiro Nishie, Yasuhiro Ushijima, Tsuyoshi Tajima, Yoshiki Asayama, Kousei Ishigami, Daisuke Kakihara, Tomohiro Nakayama, Yukihisa Takayama, Daisuke Okamoto, Koichiro Abe, Makoto Obara, Kengo Yoshimitsu, Hiroshi Honda

    EUROPEAN JOURNAL OF RADIOLOGY   81 ( 6 )   1100 - 1104   2012.6

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    Purpose: To examine whether or not the parameters regarding the signal intensity of the liver parenchyma on superparamagnetic iron oxide (SPIO)- and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI are correlated with the parameters of Technetium-99m galactosyl serum albumin (Tc-99m-GSA) scintigraphy.
    Materials and methods: This retrospective study consisted of 55 and 33 patients who underwent SPIO- and Gd-EOB-DTPA-enhanced MRI in addition to Tc-99m-GSA scintigraphy, respectively. For each patient, we calculated Pre R2* and Pre R2, which are equivalent to R2* (= 1/T2*) and R2 (= 1/T2) values of the liver parenchyma; Delta R2* and Delta R2, which represent differences in R2* and R2 values of the liver parenchyma before and after administration of SPIO; and the increase rates of both the liver-to-spleen signal intensity ratio (LSR) and the liver-to-major psoas muscle signal intensity ratio (LMR) on the hepatobiliary phase compared with the precontrast image. For Tc-99m-GSA scintigraphy, the receptor index LHL15 and the blood clearance index HH15 were recorded.
    Results: Regression analysis showed a moderate correlation between Pre R2* and LHL15 (P < 0.05). Mild to moderate correlations were also obtained between any combination of Delta R2* and Delta R2 on the one hand, and LHL15 and HH15 on the other (P < 0.05). There were moderate correlations between any combination of increase rates of LSR and LMR on the one hand, and LHL15 and HH15 on the other (P < 0.05-0.001).
    Conclusion: Pre R2*, Delta R2*, Delta R2 and the increase rates of LSR and LMR could be used as quantitative indicators of liver function. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.ejrad.2011.02.053

  • CT-guided radiofrequency ablation of osteoid osteoma in the long bones of the lower extremity. Reviewed International journal

    Asayama Y, Nishie A, Ishigami K, Kakihara D, Ushijima Y, Takayama Y, Fujita N, Tajima T, Yoshimitsu K, Matsuda S, Iwamoto Y, Honda H

    World journal of radiology   4 ( 6 )   278 - 282   2012.6

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    CT-guided radiofrequency ablation of osteoid osteoma in the long bones of the lower extremity.
    AIM: To present our initial experience with computed tomography guided radiofrequency ablation (RFA) of osteoid osteoma (OO) in our institution. METHODS: RFA was performed on eight patients (5 males and 3 females) with clinically and radiologically diagnosed OO (femoral neck, n = 4; femoral diaphysis, n = 2; tibial diaphysis, n = 1; fibular diaphysis, n = 1). Ablation was performed using an electrode with a 10-mm exposed tip for a total of 4-6 min at a targeted temperature of 90 degrees Celsius. No cooling system was used. The intervention was accepted as technically successful if the tip of the electrode could be placed within the center of the nidus. We defined clinical success as a disappearance within 2 wk after treatment of symptoms that had manifested at presentation. RESULTS: All procedures were technically successful. No major or immediate complications were observed. Clinical success was achieved in six of eight patients in the first procedure. A second procedure was performed for two patients who had recurrent or continued pain, and one of these cases was successfully treated. The overall rate of success was 87.5&#37; (7/8). No complication was observed. CONCLUSION: Our preliminary results indicate a favorable success rate and no complications and are compatible with the previous reports of RFA of OO.

    DOI: 10.4329/wjr.v4.i6.278

  • Enhancement pattern analysis of hypervascular hepatocellular carcinoma on dynamic MR imaging with histopathological correlation: Validity of portal phase imaging for predicting tumor grade Reviewed

    Daisuke Okamoto, Kengo Yoshimitsu, Akihiro Nishie, Tsuyoshi Tajima, Yoshiki Asayama, Kousei Ishigami, Masakazu Hirakawa, Yasuhiro Ushijima, Daisuke Kakihara, Tomohiro Nakayama, Yunosuke Nishihara, Shinichi Aishima, Akinobu Taketomi, Junji Kishimoto, Hiroshi Honda

    EUROPEAN JOURNAL OF RADIOLOGY   81 ( 6 )   1116 - 1121   2012.6

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    Purpose: To elucidate the correlation between hypervascular hepatocellular carcinoma (HCC) enhancement patterns on dynamic MR imaging and histological findings.
    Materials and methods: Surgically proven 46 hypervascular HCCs of forty-one patients were enrolled. For each HCC, the signal intensity in the portal phase (SIPP) was evaluated. In this study, high, iso-, or low intensity in the portal phase was hypothesized as late, moderate, or early washout pattern, respectively. The SIPP of each HCC was correlated to histological grade and architectural subtypes that represent degrees of trabecular structure. For the trabecular HCCs, the thickness of tumor plate was also correlated for indirect estimation of tumor sinusoid.
    Results: There was a significant correlation between the SIPP vs. histological grade and also vs. architectural subtypes, namely the degree of trabecular structure. Washout of hypervascular HCC occurred earlier as the histological grade advanced and the histological architecture got closer to pure trabecular HCC. For the trabecular HCCs, the thickness of tumor plate correlated significantly with SIPP or histological grade. Hypervascular HCCs with thicker tumor plates showed worse histological grade and earlier washout pattern.
    Conclusions: Histological grade of hypervascular HCC may be predicted using SIPP. The thickness of tumor plate, resultantly the size of sinusoid between tumor plates, can account for the relationship between washout pattern and histological grade in the trabecular HCCs. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.ejrad.2011.02.056

  • Radiological catheter placement for transcatheter arterial steroid injection therapy to treat severe acute hepatic failure: technical feasibility and efficacy Reviewed

    Yasuhiro Ushijima, Tsuyoshi Tajima, Kengo Yoshimitsu, Hiroyuki Irie, Akihiro Nishie, Masakazu Hirakawa, Kousei Ishigami, Daisuke Okamoto, Kazuhiro Kotoh, Hiroshi Honda

    ACTA RADIOLOGICA   53 ( 2 )   140 - 146   2012.3

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    Background: Severe acute hepatic failure (SAHF), which progresses to fulminant form in some cases, is a life-threatening disease. Purpose: To assess the technical feasibility and the efficacy of transcatheter arterial steroid injection therapy (TASIT) for SAHF.
    Material and Methods: Twenty-seven patients with SAHF, 10 of whom had variant anatomy of the hepatic artery, underwent radiologic placement of an indwelling catheter in the hepatic artery, and TASIT was subsequently performed for three days. The tips of the catheters were inserted as follows: common hepatic artery (n = 18), proper hepatic artery (n = 4), and replaced right hepatic artery (n = 5). The clinical success rate of TASIT and the prognosis after TASIT were evaluated.
    Results: In one patient, intimal injury of the left hepatic artery was encountered; however, TASIT could be resumed and completed via intrahepatic arterial collaterals. In two patients, the catheter tip placement was corrected on the following day because of dislocation. Finally, TASIT could be carried out in all patients. Twenty-two patients (81.5&#37;) responded to TASIT but five patients (18.5&#37;) did not. Among the five non-responders, two patients were transferred to liver transplantation and survived, and three patients died. There was no significant difference in the response rates to TASIT among locations of catheter tip (P > 0.05) and extent of drug distribution in the liver (P > 0.05).
    Conclusion: TASIT is a feasible and efficient treatment option for SAHF regardless of the anatomic variation of the hepatic artery. Careful manipulation during the procedure to prevent injury of the hepatic artery may be the most essential factor not only for successful TASIT but also for liver transplantation, which may be performed on TASIT non-responders.

    DOI: 10.1258/ar.2011.110373

  • An increase in the number of predictive factors augments the likelihood of malignancy in branch duct intraductal papillary mucinous neoplasm of the pancreas Reviewed

    Takao Ohtsuka, Hiroshi Kono, Yosuke Nagayoshi, Yasuhisa Mori, Kosuke Tsutsumi, Yoshihiko Sadakari, Shunichi Takahata, Katsuya Morimatsu, Shinichi Aishima, Hisato Igarashi, Tetsuhide Ito, Kousei Ishigami, Masafumi Nakamura, Kazuhiro Mizumoto, Masao Tanaka

    SURGERY   151 ( 1 )   76 - 83   2012.1

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    Background. International consensus guidelines for the management of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas provide several factors that can be used to predict which IPMNs will become malignant. The sensitivity of each factor's predictive accuracy, however, is relatively low, making it difficult to determine the appropriate treatment in individual cases. The aim of this study was to investigate whether increasing the number of predictive factors might augment the sensitivity of the established guidelines to detect malignant IPMNs.
    Methods. The medical records of 138 patients with IPMNs resected at our institution were reviewed. Possible malignant predictors were analyzed by univariate and multivariate analysis, and the effects of the number of factors and the predictive score of the pathologic results were examined. The cutoff points for the number of predictors to discriminate between malignant and nonmalignant IPMNs were established by constructing receiver operating characteristic curves.
    Results. A predictive analysis could not be carried out for the main duct IPMNs because of the high prevalence of malignancy and the small number of significant predictors associated with them. For malignant branch duct IPMNs, however, we identified 4 predictive factors that helped determine the correct diagnosis as follows: (I) the presence of a cyst >= 30 mm in diameter; (2) the presence of mural nodules; (3) a history of acute pancreatitis; and (4) atypical results of pancreatic juice cytology. An increase in the number of these factors significantly affected the sensitivity to predict malignancy. The area under the curve for the number of predictors for malignant branch duct IPMNs was 0.856, and the sensitivity and specificity were 96&#37; and 71&#37;, respectively, when the cutoff point was set at 2. The predictive scoring system also showed the same values of sensitivity and specificity for the number of factors.
    Conclusion. Patients with branch duct IPMNs who have 2 or more of the 4 predictive factors described above should undergo standard pancreatectomy with lymph node dissection, whereas patients who present with 0 or 1 predictive factor can be treated by minimal pancreatectomy without nodal dissection or by careful observation without resection. All patients with main duct IPMNs, therefore, should be treated with resection.as suspected malignancies. (Surgery 2012;151:76-83.)

    DOI: 10.1016/j.surg.2011.07.009

  • Uptake of Gd-EOB-DTPA by hepatocellular carcinoma: Radiologic-pathologic correlation with special reference to bile production Reviewed

    Yoshiki Asayama, Tsuyoshi Tajima, Akihiro Nishie, Kousei Ishigami, Daisuke Kakihara, Tomohiro Nakayama, Daisuke Okamoto, Nobuhiro Fujita, Shinichi Aishima, Ken Shirabe, Hiroshi Honda

    EUROPEAN JOURNAL OF RADIOLOGY   80 ( 3 )   E243 - E248   2011.12

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    Purpose: The aim of this study was to reveal the relationship between intratumoral uptake of gadoliniumethoxylbenzyldiethylenetriaminepentaacetic acid (Gd-EOB-DTPA) of hepatocellular carcinoma (HCC) in the hepatobiliary phase and pathological features.
    Materials and methods: Sixty HCC nodules were confirmed at pathology in 56 patients who had undergone dynamic MRI. T1-weighted 3D gradient echo sequences before and 20 min (hepatobiliary phase) after the injection of Gd-EOB-DTPA were performed. Uptake of Gd-EOB-DTPA was defined as an increase in signal intensity in the hepatobiliary phase compared with the precontrast scan. All surgical specimens were fixed with formalin and then digitally photographed. The relationship between Gd-EOB-DTPA uptake and histological findings, including a macroscopic greenish area, was examined.
    Results: MR images showed uptake of Gd-EOB-DTPA in twenty-two nodules. Histological findings indicated twenty-six nodules contained a greenish area. There is a significant correlation between HCC showing Gd-EOB-DTPA uptake and the presence of a greenish area (p < 0.001). On a nodule-by-nodule basis, more than two-thirds of the area of Gd-EOB DTPA uptake coincides with the greenish part in only 12 of 22 lesions (54.5&#37;). More than two-thirds of the greenish area coincided with that of Gd-EOB-DTPA uptake in only 10 of 26 cases (38.5&#37;).
    Conclusion: The area of Gd-EOB-DTPA uptake does not always match the greenish part, but HCC with uptake of Gd-EOB-DTPA significantly correlated with green HCC. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.ejrad.2010.10.032

  • Hepatocellular carcinoma with marginal superparamagnetic iron oxide uptake on T2*-weighted magnetic resonance imaging: Histopathologic correlation Reviewed

    Kousei Ishigami, Tsuyoshi Tajima, Nobuhiro Fujita, Akihiro Nishie, Yoshiki Asayama, Daisuke Kakihara, Tomohiro Nakayama, Daisuke Okamoto, Akinobu Taketomi, Ken Shirabe, Hiroshi Honda

    EUROPEAN JOURNAL OF RADIOLOGY   80 ( 3 )   E293 - E298   2011.12

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    Purpose: To evaluate the characteristics of hepatocellular carcinomas (HCCs) with marginal superparamagnetic iron oxide (SPIO) uptake on T2*-weighted MRI.
    Materials and methods: The study group consisted of 73 patients with 83 surgically resected HCCs. Preoperative SPIO-enhanced MRI studies were retrospectively reviewed. Marginal SPIO uptake was considered positive if a rim-like or band-like low intensity area was present on SPIO-enhanced T2*-weighted images. The prevalence of marginal SPIO uptake was evaluated. Pathological specimens with hematoxylin and eosin staining and immunohistochemical staining of CD68 were reviewed in HCCs with marginal SPIO uptake and 33 HCCs without marginal SPIO uptake (control group).
    Results: Ten of 83 (12&#37;) HCCs showed marginal SPIO uptake. All HCCs were hypervascular, and only one nodule showed a nodule-in-nodule appearance on imaging findings. The pathology specimens suggested possible causes of marginal SPIO uptake, including marginal macrophage infiltration in moderately or poorly differentiated HCC (n = 4), residual normal hepatic tissue at the marginal area of confluent multinodular or single nodular with extranodular growth type HCC (n = 3), and a well-differentiated HCC component in nodule-in-nodule type HCC (n = 3). Marginal macrophage infiltration was not seen in the control group.
    Conclusion: SPIO-enhanced MRI may be able to demonstrate marginal macrophage infiltration in HCC. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.ejrad.2010.12.078

  • Diagnostic performance of apparent diffusion coefficient for predicting histological grade of hepatocellular carcinoma Reviewed

    Akihiro Nishie, Tsuyoshi Tajima, Yoshiki Asayama, Kousei Ishigami, Daisuke Kakihara, Tomohiro Nakayama, Yukihisa Takayama, Daisuke Okamoto, Nobuhiro Fujita, Akinobu Taketomi, Kengo Yoshimitsu, Hiroshi Honda

    EUROPEAN JOURNAL OF RADIOLOGY   80 ( 2 )   E29 - E33   2011.11

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    Objective: To investigate whether the histological grade of hepatocellular carcinoma (HCC) can be predicted using the apparent diffusion coefficient (ADC).
    Materials and Methods: This retrospective study group consisted of 80 patients with 85 surgically resected HCCs who underwent preoperative MRI exams including diffusion-weighted imaging. The tumors were histologically classified into five groups as follows: five well (w-), 17 well to moderately (wm-), 37 moderately (m-), 16 moderately to poorly (mp-), and 10 poorly (p-) differentiated HCCs. For ADC measurement of each HCC, the largest possible region of interest was placed on the solid region on the ADC map where ADC was considered to be the lowest. The average ADCs of the five histological grades were compared using Spearman's rank correlation test and Student's t-test, and the diagnostic performance of ADC for mp- and p- HCCs was also evaluated using a receiver operating characteristic-based positive test.
    Results: The average ADC of p- HCC (0.76 +/- 0.10 x 10(-3) mm(2)/s) was significantly lower than those of the other four histological grades. The average ADC of mp- HCCs (0.99 +/- 0.20 x 10(-3) mm(2)/s) was significantly lower than those of w-, wm- and m- HCCs. The sensitivity, specificity, PPV, NPV, and accuracy, when an ADC of 0.972 or lower was considered an indicator of mp- and p- HCCs, were 73.1&#37;, 72.9&#37;, 54.3&#37;, 86.0&#37; and 72.9&#37;, respectively.
    Conclusion: ADCs of mp- and p-HCCs were lower than those of w-, wm- and m-HCCs. ADC can contribute to radiological diagnosis of poorly differentiated components in HCCs. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.ejrad.2010.06.019

  • The prevalence of circumportal pancreas as shown by multidetector-row computed tomography. Reviewed International journal

    Ishigami K, Tajima T, Nishie A, Asayama Y, Kakihara D, Nakayama T, Shirabe K, Taketomi A, Nakamura M, Takahata S, Ito T, Honda H

    Insights into imaging   2 ( 4 )   409 - 414   2011.8

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    The prevalence of circumportal pancreas as shown by multidetector-row computed tomography.
    OBJECTIVE: To evaluate the prevalence of circumportal pancreas (CP) and any coexisting anomaly. In addition, three cases of surgically confirmed CP are presented. METHODS: The study group consisted of 317 consecutive potential liver transplant donor candidates who had undergone thin-section MDCT studies for the evaluation of vascular anatomy. MDCT images were retrospectively reviewed to assess the presence or absence of CP. If CP was present, the transverse diameter of the aberrant pancreatic tissue was measured on axial images, and the course of the main pancreatic duct (MPD) was classified into ante-portal (normal) or retro-portal. In addition, the prevalence of variant hepatic arterial anatomy was compared between cases with and without CP. RESULTS: Eight of 317 liver transplant donor candidates (2.5&#37;) were found to have CP at CT. The transverse diameter of the aberrant pancreatic tissue ranged from 5 to 18 mm (mean ± SD: 10 ± 4 mm). One of eight (12.5&#37;) showed the MPD to be retro-portal. A variant hepatic artery was noted in two of the of eight (25&#37;) patients, which was similar to the finding for those without CP [72 out of 309 (23&#37;)]. CONCLUSION: The prevalence of circumportal pancreas was 2.5&#37;.

    DOI: 10.1007/s13244-011-0092-5

  • Performance of radiological methods in diagnosing hepatocellular carcinoma preoperatively in a recipient of living related liver transplantation: Comparison with step section histopathology Reviewed

    Masakazu Hirakawa, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Daisuke Kakihara, Akinobu Taketomi, Shin-Ichi Aishima, Hiroshi Honda

    Japanese Journal of Radiology   29 ( 2 )   129 - 137   2011.2

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    Purpose: The aim of the present study was to evaluate the performance of multidetector-row CT (MDCT) and magnetic resonance imaging (MRI) in diagnosing hepatocellular carcinoma (HCC) preoperatively in living related liver transplantation (LRLT) recipients with liver cirrhosis and HCC. Materials and methods: A total of 25 LRLT recipients with 89 pathologically proved HCCs underwent dynamic 4-row MDCT (5 mm collimation) and MRI within 1 month before LRLT. The images were reviewed for the diagnosis of HCC on a tumor-by-tumor basis by three observers independently and randomly using explanted specimens as the gold standard. The diagnostic accuracy of these techniques in the detection of HCC was assessed with alternative free response receiver operating characteristic (ROC) analysis. The sensitivity and positive predictive values were evaluated. Results: The average values of the area under the ROC curve (Az) of MRI images were higher than those obtained with MDCT
    however, no significant difference was observed (P &gt
    0.05). The overall sensitivity of HCC with MRI was higher than that with MDCT, especially in the case of HCCs &lt
    20 mm. Conclusion: A better diagnostic performance regarding HCCs in LRLT recipients was achieved with MRI than with MDCT, although no significant difference was observed. © 2011 Japan Radiological Society.

    DOI: 10.1007/s11604-010-0528-8

  • Performance of radiological methods in diagnosing hepatocellular carcinoma preoperatively in a recipient of living related liver transplantation: comparison with step section histopathology Reviewed

    Masakazu Hirakawa, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Daisuke Kakihara, Akinobu Taketomi, Shin-ichi Aishima, Hiroshi Honda

    JAPANESE JOURNAL OF RADIOLOGY   29 ( 2 )   129 - 137   2011.2

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    The aim of the present study was to evaluate the performance of multidetector-row CT (MDCT) and magnetic resonance imaging (MRI) in diagnosing hepatocellular carcinoma (HCC) preoperatively in living related liver transplantation (LRLT) recipients with liver cirrhosis and HCC.
    A total of 25 LRLT recipients with 89 pathologically proved HCCs underwent dynamic 4-row MDCT (5 mm collimation) and MRI within 1 month before LRLT. The images were reviewed for the diagnosis of HCC on a tumor-by-tumor basis by three observers independently and randomly using explanted specimens as the gold standard. The diagnostic accuracy of these techniques in the detection of HCC was assessed with alternative free response receiver operating characteristic (ROC) analysis. The sensitivity and positive predictive values were evaluated.
    The average values of the area under the ROC curve (Az) of MRI images were higher than those obtained with MDCT; however, no significant difference was observed (P > 0.05). The overall sensitivity of HCC with MRI was higher than that with MDCT, especially in the case of HCCs < 20 mm.
    A better diagnostic performance regarding HCCs in LRLT recipients was achieved with MRI than with MDCT, although no significant difference was observed.

    DOI: 10.1007/s11604-010-0528-8

  • Erratum: Noninvasive estimation of hepatic steatosis using plain CT vs. chemical-shift MR imaging: Significance for living donors (Journal of Magnetic Resonance Imaging (2008) 28 (678-684)) Reviewed

    Kengo Yoshimitsu, Yousuke Kuroda, Makoto Nakamuta, Akinobu Taketomi, Hiroyuki Irie, Tsuyoshi Tajima, Masakazu Hirakawa, Kousei Ishigami, Yasuhiro Ushijima, Tomomi Yamada, Hiroshi Honda

    Journal of Magnetic Resonance Imaging   33 ( 1 )   255   2011.1

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    DOI: 10.1002/jmri.22411

  • Safety Margins of Hepatocellular Carcinoma Demonstrated by 3-Dimensional Fused Images of Computed Tomographic Hepatic Arteriography/Unenhanced Computed Tomography: Prognostic Significance in Patients Who Underwent Transcatheter Arterial Chemoembolization Reviewed

    Tsuyoshi Tajima, Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Yasuhiro Ushijima, Daisuke Kakihara, Hiroshi Honda

    JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY   34 ( 5 )   712 - 719   2010.9

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    Objective: To investigate the relation between safety margins (SMs) and treatment efficacy for hepatocellular carcinoma (HCC) by transcatheter arterial chemoembolization (TACE) using 3-dimensional fusion images of computed tomographic (CT) hepatic arteriography and unenhanced CT.
    Methods: Fifty-three patients with HCC who underwent subsegmental/segmental TACE were followed up. Lipiodol accumulation patterns within the lesion were classified as determined by unenhanced CT immediately after TACE. Lipiodol accumulation patterns around the lesion were classified as determined by 3-dimensional fusion images with special reference to the SMs, which were compared with the local recurrence (LR) rates.
    Results: Local recurrence was detected in 29 patients (55&#37;) during the follow-up period. When an SM less than 3 mm was defined as insufficient, the LR rates in groups with and without sufficient SMs were 33&#37; (9/25) and 71&#37; (20/28), respectively (P = 0.0136). In 38 nodules with complete Lipiodol accumulation, 10 (63&#37;) of 16 nodules with LR showed the narrow SM (<3 mm), whereas 5 (23&#37;) of 22 nodules without LR showed the narrow SM (P = 0.1341). Multivariate analyses showed that complete Lipiodol accumulation seemed to be an independent prognostic factor (P = 0.0288).
    Conclusions: 3-Dimensional fusion image was suggested to be valuable for the early detection of viable components within the HCC with insufficient SMs after TACE.

    DOI: 10.1097/RCT.0b013e3181e1d241

  • Spectrum of Unusual Imaging Findings of Metastatic Lesions from Gastric Cancer Reviewed

    Kousei Ishigami, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Akihiro Nishie, Masakazu Hirakawa, Yasuhiro Ushijima, Daisuke Okamoto, Akihiro Ino, Eriko Kiyosawa, Masahiro Sakai, Aya Hirata, Hiroshi Honda

    CURRENT MEDICAL IMAGING REVIEWS   6 ( 3 )   171 - 177   2010.8

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    Purpose: The purpose of this pictorial review was to present imaging findings of various unusual metastatic lesions from gastric cancer.
    Conclusion: Because of its tendency to cause the development of peritoneal implants, diffuse retroperitoneal tumor infiltration, and lymphangitic spread, poorly differentiated gastric adenocarcinoma can involve various organs and superficial regions. In addition, metastasis from alpha-fetoprotein (AFP)-producing gastric cancer may show giant lymph node metastasis, portal venous tumor thrombus, and hypervascular liver metastasis.

    DOI: 10.2174/157340510791636309

  • Radiological assessment of hepatic vein invasion by hepatocellular carcinoma using combined computed tomography hepatic arteriography and computed tomography arterial portography Reviewed

    Akihiro Nishie, Tsuyoshi Tajima, Yoshiki Asayama, Kousei Ishigami, Masakazu Hirakawa, Yasuhiro Ushijima, Daisuke Kakihara, Daisuke Okamoto, Nobuhiro Fujita, Akinobu Taketomi, Kengo Yoshimitsu, Hiroshi Honda

    Japanese Journal of Radiology   28 ( 6 )   414 - 422   2010.7

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    Purpose: The aim of this study was to elucidate computed tomography hepatic arteriography (CTHA) and CT arterial portography (CTAP) findings characteristic of hepatocellular carcinoma (HCC) with large hepatic venous invasion (HVI) and then to examine whether the presence of minute HVI can be diagnosed based on each finding. Materials and methods: Combined CTHA and CTAP of 106 HCCs were examined. Two radiologists analyzed the radiological findings of five nodules with large HVI (group vv2). The remaining 101 nodules were classified into two groups: group vv1, positive minute HVI
    group vv0, negative HVI. They examined whether each finding observed in group vv2 could be detected in groups vv1 and vv0. Results: Analysis of group vv2 identified (a) tumor thrombus, (b) early inflow of the contrast into the hepatic vein proximal to the invaded site, and (c) partially decreased portal venous flow in the peripheral parenchyma subject to the involved hepatic vein. Findings (b) and (c) were observed in 16&#37; of group vv1. A significant difference in frequency of finding (c) was obtained between groups vv1 and vv0. The positive and negative predictive values of finding (c) were 66.7&#37; and 77.9&#37;, respectively. Conclusion: Findings (b) and (c), especially the latter, may partly contribute to the radiological diagnosis of minute HVI. © 2010 Japan Radiological Society.

    DOI: 10.1007/s11604-010-0442-0

  • Imaging of cholangiolocellular carcinoma of the liver Reviewed

    Yoshiki Asayama, Tsuyoshi Tajima, Daisuke Okamoto, Akihiro Nishie, Kousei Ishigami, Yasuhiro Ushijima, Daisuke Kakihara, Shinichi Aishima, Akinobu Taketomi, Hiroshi Honda

    EUROPEAN JOURNAL OF RADIOLOGY   75 ( 1 )   E120 - E125   2010.7

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    Aim: Cholangiolocellular carcinoma (CoCC) is currently considered to originate from hepatic progenitor cells. The purpose of this study was to evaluate the imaging features of cholangiolocellular carcinoma of the liver.
    Materials and methods: Five cases of surgically resected cases of CoCC from 4 institutions were retrospectively evaluated. All of the five patients underwent contrast-enhanced dynamic CT. MRI and angio-CT including CT during arterioportography (CTAP) and CT during hepatic arteriography were performed in 3 and 2 patients, respectively. Histological evaluation was also performed and was correlated with radiographic findings.
    Results: On dynamic CT or MRI, the lesions presented hypervascular tumors with delayed washout in 2 cases and in the other 3 cases, the lesions showed peripheral enhancement with concentric delayed filling. On CTAP, the continued existence of portal veins or tiny spots of portal flow was identified in the tumors. Fibrous capsule or tumor necrosis was not observed.
    Conclusion: CoCC tumors have the dual imaging characteristics of hepatocellular carcinoma and cholangiocarcinoma. The absence of a fibrous capsule, the absence of tumor necrosis, peripheral location within the liver, and the presence of portal venous penetration within the tumor also appear to be characteristic features. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.ejrad.2009.09.010

  • Radiological assessment of hepatic vein invasion by hepatocellular carcinoma using combined computed tomography hepatic arteriography and computed tomography arterial portography Reviewed

    Akihiro Nishie, Tsuyoshi Tajima, Yoshiki Asayama, Kousei Ishigami, Masakazu Hirakawa, Yasuhiro Ushijima, Daisuke Kakihara, Daisuke Okamoto, Nobuhiro Fujita, Akinobu Taketomi, Kengo Yoshimitsu, Hiroshi Honda

    JAPANESE JOURNAL OF RADIOLOGY   28 ( 6 )   414 - 422   2010.7

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    The aim of this study was to elucidate computed tomography hepatic arteriography (CTHA) and CT arterial portography (CTAP) findings characteristic of hepatocellular carcinoma (HCC) with large hepatic venous invasion (HVI) and then to examine whether the presence of minute HVI can be diagnosed based on each finding.
    Combined CTHA and CTAP of 106 HCCs were examined. Two radiologists analyzed the radiological findings of five nodules with large HVI (group vv2). The remaining 101 nodules were classified into two groups: group vv1, positive minute HVI; group vv0, negative HVI. They examined whether each finding observed in group vv2 could be detected in groups vv1 and vv0.
    Analysis of group vv2 identified (a) tumor thrombus, (b) early inflow of the contrast into the hepatic vein proximal to the invaded site, and (c) partially decreased portal venous flow in the peripheral parenchyma subject to the involved hepatic vein. Findings (b) and (c) were observed in 16&#37; of group vv1. A significant difference in frequency of finding (c) was obtained between groups vv1 and vv0. The positive and negative predictive values of finding (c) were 66.7&#37; and 77.9&#37;, respectively.
    Findings (b) and (c), especially the latter, may partly contribute to the radiological diagnosis of minute HVI.

    DOI: 10.1007/s11604-010-0442-0

  • MRI findings of pancreatic lymphoma and autoimmune pancreatitis: A comparative study Reviewed

    Kousei Ishigami, Tsuyoshi Tajima, Akihiro Nishie, Yasuhiro Ushijima, Nobuhiro Fujita, Yoshiki Asayama, Daisuke Kakihara, Hiroyuki Irie, Tetsuhide Ito, Hisato Igarashi, Masafumi Nakamura, Hiroshi Honda

    EUROPEAN JOURNAL OF RADIOLOGY   74 ( 3 )   E23 - E29   2010.6

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    Purpose: To clarify whether there are differences in MRI findings between pancreatic lymphomas and autoimmune pancreatitis (AIP).
    Materials and methods: MRI of 8 patients with pancreatic lymphomas and 21 patients with AIP were retrospectively reviewed. For multifocal pancreatic lymphomas (n = 2) and AIP (n = 4), the largest 2 lesions were evaluated. Ten pancreatic lymphomas and 25 AIP were compared on three bases: the signal intensity on T2-weighted images, internal homogeneity, and presence or absence of capsule-like rim. In 8 lymphomas and 19 AIP, the enhancement pattern on dynamic MRI was compared, as well.
    Results: On T2-weighted images, pancreatic lymphomas comprised 5, 5 and 4 lesions with low (iso), slightly high, and moderately high intensity, respectively, while the numbers for AIP were 14, 10, and 1 (P < 0.01). Nine of 10 (90&#37;) lymphomas appeared homogenous, and 11 of 25 (44&#37;) AIP were homogenous (P < 0.05). A capsule-like rim was present in 9 of 25 (36&#37;) AIP, but was not seen in lymphomas (P < 0.05). On dynamic MRI, 18 of 19 (94.7&#37;) AIP showed persistent (n = 5) or delayed enhancement (n = 13), and 6 of 8 (75&#37;) lymphomas showed low intensity without delayed enhancement (P < 0.001).
    Conclusion: MRI findings for pancreatic lymphomas and AIP were significantly different, which may be helpful for the differential diagnosis of these two diseases. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.ejrad.2009.03.022

  • Differential diagnosis of groove pancreatic carcinomas vs. groove pancreatitis: Usefulness of the portal venous phase Reviewed

    Kousei Ishigami, Tsuyoshi Tajima, Akihiro Nishie, Daisuke Kakihara, Nobuhiro Fujita, Yoshiki Asayama, Yasuhiro Ushijima, Hiroyuki Irie, Masafumi Nakamura, Shunichi Takahata, Tetsuhide Ito, Hiroshi Honda

    EUROPEAN JOURNAL OF RADIOLOGY   74 ( 3 )   E96 - E101   2010.6

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    Purpose: To clarify if the portal venous phase is helpful for the differential diagnosis of groove pancreatic carcinomas and groove pancreatitis.
    Materials and methods: MDCT and MRI of groove pancreatic carcinomas (n=7) and groove pancreatitis (n=15) were retrospectively reviewed by two radiologists independently. The signal intensity on T2-weighted images was subjectively assessed. The presence or absence of common bile duct (CBD) and main pancreatic duct (MPD) strictures, calcifications, and cystic lesions was evaluated. Additionally, the appearance of groove pancreatic carcinoma and that of groove pancreatitis in the portal venous phase on dynamic MDCT and MRI were compared.
    Results: There were no significant differences in the signal intensity on T2-weighted images and in the presence or absence of CBD and MPD strictures, calcifications, and cystic lesions between groove pancreatic carcinomas and groove pancreatitis. However, patchy focal enhancement in the portal venous phase was more commonly observed in groove pancreatitis than groove pancreatic carcinoma (Reviewers 1 and 2: 14/15 [93.3&#37;] vs. 1/7 [14.3&#37;], P<0.0001). In addition, peripheral enhancement was only seen in groove pancreatic carcinomas (Reviewer 1: 4/7 [57.1&#37;] vs. 0/15 [0&#37;], P<0.005, and Reviewer 2: 3/7 [42.9&#37;] vs. 0/15 [0&#37;], P<0.05).
    Conclusion: The portal venous phase may be helpful for the differential diagnosis of groove pancreatic carcinomas and groove pancreatitis. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.ejrad.2009.04.026

  • Recanalization of Splenic Artery Aneurysm After Transcatheter Arterial Embolization Using N-Butyl Cyanoacrylate Reviewed

    Keiji Matsumoto, Yasuhiro Ushijima, Tsuyoshi Tajima, Akihiro Nishie, Masakazu Hirakawa, Kousei Ishigami, Yukiko Yamaji, Hiroshi Honda

    CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY   33 ( 1 )   187 - 190   2010.2

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    A 65-year-old woman who had been diagnosed as having microscopic polyangiitis developed sudden abdominal pain and entered a state of shock. Abdominal CT showed massive hemoperitoneum, and emergent angiography revealed a ruptured splenic artery aneurysm. After direct catheterization attempts failed due to tortuous vessels and angiospasm, transcatheter arterial embolization using an n-butyl cyanoacrylate (NBCA)-lipiodol mixture was successfully performed. Fifty days later, the patient developed sudden abdominal pain again. Repeated angiography demonstrated recanalization of the splenic artery and splenic artery aneurysm. This time, the recanalized aneurysm was embolized using metallic coils with the isolation method. Physicians should keep in mind that recanalization can occur after transcatheter arterial embolization using N-butyl cyanoacrylate, which has been used as a permanent embolic agent.

    DOI: 10.1007/s00270-009-9627-2

  • Detection of Hepatocellular Carcinoma (HCC) Using Super Paramagnetic Iron Oxide (SPIO)-Enhanced MRI: Added Value of Diffusion-Weighted Imaging (DWI) Reviewed

    Akihiro Nishie, Tsuyoshi Tajima, Kousei Ishigami, Yasuhiro Ushijima, Daisuke Okamoto, Masakazu Hirakawa, Yunosuke Nishihara, Akinobu Taketomi, Masamitsu Hatakenaka, Hiroyuki Irie, Kengo Yoshimitsu, Hiroshi Honda

    JOURNAL OF MAGNETIC RESONANCE IMAGING   31 ( 2 )   373 - 382   2010.2

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    Purpose: To evaluate whether diffusion-weighted imaging (DWI) improves the detection of hepatocellular carcinoma (HCC) on super paramagnetic iron oxide (SPIO)-enhanced MRI.
    Materials and Methods: This retrospective study group consisted of 30 patients with 50 HCC nodules who underwent MRI at 1.5 Tesla. Two combined MR sequence sets were compared for detecting HCC: SPIO-enhanced MRI (axial T2-weighted fast spin-echo (FSE) and T1-/T2*-weighted fast field echo (FFE) scanned before and after administration of ferucarbotran) and SPIO-enhanced MRI + DWI (SPIO-enhanced MRI With axial DWI scanned before and after administration of ferucarbotran). Three blinded readers independently reviewed for the presence of HCC on a segment-by-segment basis using a four-point confidence scale. The performance of the two combined MR sequence sets was evaluated using receiver operating characteristic (ROC) analysis.
    Results: The average area under the ROC curve (Az) of the three readers for the SPIO-enhanced MRI + DWI set (0.870 +/- 0.046) was significantly higher that that for the SPIO-enhanced MRI set (0.820 +/- 0.055) (P = .025). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detection of HCC were 66.0&#37;, 98.0&#37;, 90.0&#37;, and 91.4&#37;, respectively, for the SPIO-enhanced MRI set, and 70.0&#37;, 98.6&#37;, 92.9&#37;, and 92.4&#37;, respectively, for the SPIO-enhanced MRI + DWI set.
    Conclusion: The SPIO-enhanced MRI + DWI set outperformed the SPIO-enhanced MRI set for depicting HCC.

    DOI: 10.1002/jmri.22059

  • MR Prediction of Postnatal Outcomes in Left-Sided Congenital Diaphragmatic Hernia Using Right Lung Signal Intensity: Comparison With That Using Right Lung Volume Reviewed

    Akihiro Nishie, Tsuyoshi Tajima, Yoshiki Asayama, Kousei Ishigami, Masakazu Hirakawa, Tomohiro Nakayama, Yasuhiro Ushijima, Daisuke Kakihara, Daisuke Okamoto, Takashi Yoshiura, Kouji Masumoto, Tomoaki Taguchi, Kiyomi Tsukimori, Shoji Tokunaga, Hiroyuki Irie, Kengo Yoshimitsu, Hiroshi Honda

    JOURNAL OF MAGNETIC RESONANCE IMAGING   30 ( 1 )   112 - 120   2009.7

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    Purpose: (1)To investigate the validity of the fetal right lung-to-liver signal intensity ratio (LLSIR) for prediction of postnatal outcomes in left-sided congenital diaphragmatic hernia (CDH).
    Materials and Methods: The study included 14 pregnant women who underwent MR exams for evaluation of fetal left-sided CDH. The fetuses were divided into two groups: Group A (n = 9), alive, and Group B (n = 5), dead. On the basis of the half-Fourier acquisition single-shot turbo spin-echo sequence, LLSIR and the right fetal lung volume (FLV) was calculated. In the control group, a regression analysis was performed to associate LLSIR and right FLV with gestational age. The relative LLSIR and right FLV (the observed/expected LLSIR and right FLV) were compared between Groups A and B.
    Results: The mean relative LLSIR, as well as the mean relative right FLV, of Group A was significantly higher than that of Group B (p = 0.035). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the relative LLSIR and the relative right FLV, when the cutoff point was defined as 0.646 and 0.420, were the same and were 88.9&#37;, 80.0&#37;, 88.9&#37;, 80.0&#37;, and 85.7&#37;, respectively.
    Conclusion: The postnatal outcomes in left-sided CDH may be predicted using the LLSIR.

    DOI: 10.1002/jmri.21829

  • Hemorrhagic mesenteric cystic lymphangioma presenting with acute lower abdominal pain: The diagnostic clues on MR Imaging Reviewed

    Daisuke Okamoto, Kousei Ishigami, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Akihiro Nishie, Masakazu Hirakawa, Yasuhiro Ushijima, Yunosuke Nishihara, Yoshihiro Kakeji, Hiroshi Honda

    Emergency Radiology   16 ( 4 )   327 - 330   2009.7

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    A 32-year-old woman complained of acute lower abdominal pain. Computed tomography showed a complex multilocular cystic mass at the right adnexal region. Magnetic resonance imaging demonstrated the origin of the mass to be the small bowel mesentery. Chemical-shift images detected septal fat of the cystic mass and suggested a small amount of fat within the locules of the cyst. A cystic tumor of the mesentery such as cystic lymphangioma, hemangioma, cystic mesothelioma, and dermoid was included in the differential diagnoses. The diagnosis of a hemorrhagic mesenteric cystic lymphangioma was confirmed at surgery and pathologic analysis. Cystic lymphangioma should be included in the differential diagnosis of acute abdominal pain. The detection of septal fat may be helpful in the diagnosis of cystic lymphangioma when it shows unusual radiological appearances. © 2008 Am Soc Emergency Radiol.

    DOI: 10.1007/s10140-008-0747-9

  • Uterine Artery Embolization Along With the Administration of Methotrexate for Cervical Ectopic Pregnancy: Technical and Clinical Outcomes Reviewed

    Masakazu Hirakawa, Tsuyoshi Tajima, Kengo Yoshimitsu, Hiroyuki Irie, Kousei Ishigami, Hideaki Yahata, Norio Wake, Hiroshi Honda

    AMERICAN JOURNAL OF ROENTGENOLOGY   192 ( 6 )   1601 - 1607   2009.6

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    OBJECTIVE. The objective of our study was to evaluate the technical and clinical outcomes of uterine artery embolization (UAE) along with the administration of methotrexate (MTX) for cervical ectopic pregnancy with vaginal bleeding as an alternative nonsurgical treatment to control bleeding and preserve fertility.
    MATERIALS AND METHODS. Eight patients (age range, 24-37 years; mean age, 30.1 years) with cervical ectopic pregnancy were treated with UAE using gelatin sponge particles to control vaginal bleeding. In seven patients, the administration of MTX was performed before, after, or before and after UAE. The follow-up periods after UAE ranged from 4 to 46 months (median, 8 months). We evaluated the UAE technique, clinical outcomes, complications, and fertility.
    RESULTS. In all patients, UAE could control active vaginal bleeding on gynecologic examination. In six patients, the cervical ectopic pregnancy was dramatically resolved. In the other two patients presenting with both fetal heartbeat before UAE and persistent high HCG levels, active vaginal rebleeding was observed. The rebleeding was successfully controlled by a second UAE procedure. No major complication related to UAE was detected. The uterus could be preserved in all patients. In seven patients, normal menses resumed within 2 months after UAE. In only one patient, amenorrhea continued 8 months after UAE. In all three patients who could be followed for 2 years or more, three had subsequent successful natural pregnancies, and two patients had live births.
    CONCLUSION. UAE along with the administration of MTX is effective in treating cervical ectopic pregnancy with vaginal bleeding while allowing the preservation of fertility.

    DOI: 10.2214/AJR.08.1921

  • Radiological detectability of minute hepatic venous invasion in hepatocellular carcinoma Reviewed

    Akihiro Nishie, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Masakazu Hirakawa, Kousei Ishigami, Yasuhiro Ushijima, Daisuke Okamoto, Yunosuke Nishihara, Akinobu Taketomi, Hiroshi Honda

    EUROPEAN JOURNAL OF RADIOLOGY   70 ( 3 )   517 - 524   2009.6

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    Objective: To determine if minute hepatic venous invasion in hepatocellular carcinoma (HCC) can be diagnosed radiologically.
    Materials and methods: CT hepatic arteriography (CTHA) and CT arterioportography (CTAP) of 95 cases with HCCs were examined. Histopathology after surgery has been the gold standard in all patients. Based on the presence of microscopic portal venous invasion (MPVI) and microscopic hepatic venous invasion (MHVI), the cases were classified into four groups as follows: Group vp0vv0, negative MPVI and MHVI; Group vp1vv0, positive MPVI and negative MHVI; Group vp0vv1, negative MPVI and positive MHVI; Group vp1vv1, positive MPVI and MHVI. An area showing low attenuation on CTAP and high attenuation on CTHA around the tumor was defined as an area of peritumoral hemodynamic change (APTHC). The shape and size of APTHC were compared between Groups vp0vv1 and vp0vv0 or between Groups vp1vv1 and vp1vv0. The ratio of APTHC volume to tumor volume (RAT) was employed as an indicator of APTHC size. Each comparison was also made independently when tumor diameter was limited to either less than 3 cm or 3 cm or more.
    Results: Three types of APTHC were identified: wedge-shaped, belt-shaped or irregular, and linear. No significant difference in the frequency of each type of APTHC was observed between Groups vp0vv1 and vp0vv0 or between Groups vp1vv1 and vp1vv0. There was no significant difference in RAT between Groups vp0vv1 and vp0vv0 or between Groups vp1vv1 and vp1vv0, unrelated to tumor size.
    Conclusions: The presence of minute hepatic venous invasion in HCC is difficult to determine even on combined CTHA and CTAP. (C) 2008 Published by Elsevier Ireland Ltd.

    DOI: 10.1016/j.ejrad.2008.02.021

  • Hepatocellular Carcinoma with a Pseudocapsule on Gadolinium-enhanced MR Images: Correlation with Histopathologic Findings Reviewed

    Kousei Ishigami, Kengo Yoshimitsu, Yunosuke Nishihara, Hiroyuki Irie, Yoshiki Asayama, Tsuyoshi Tajima, Akihiro Nishie, Masakazu Hirakawa, Yasuhiro Ushijima, Daisuke Okamoto, Akinobu Taketomi, Hiroshi Honda

    RADIOLOGY   250 ( 2 )   435 - 443   2009.2

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    Purpose: To evaluate the characteristics of hepatocellular carcinoma (HCC) with a pseudocapsule on dynamic magnetic resonance (MR) images.
    Materials and Methods: The institutional review board approval was obtained, and the requirements for informed consent were waived for this retrospective study. Dynamic MR studies of surgically resected 106 HCCs in 93 patients were retrospectively reviewed. A false-positive fibrous capsule (FC) on dynamic MR images was considered to be a pseudocapsule. Pathologic specimens of HCCs with a pseudocapsule were reviewed. The differences in size, tumor grade, the degree of liver fibrosis and background liver diseases, and the incidence of vascular invasion were compared between HCCs with a pseudocapsule on MR images and those with FC at histologic examination by using Student t, Kruskal-Wallis, and chi(2) tests.
    Results: The sensitivity, specificity, and accuracy of dynamic MR in the diagnosis of histologic FC were 94.0&#37; (47 of 50), 73.2&#37; (41 of 56), and 83.0&#37; (88 of 106), respectively. There were 15 (14.2&#37;) HCCs with a pseudocapsule. The pathologic specimens suggested possible causes of the pseudocapsule that included prominent sinusoids (n = 6), peritumoral fibrosis mimicking bridging fibrosis (n = 3), and both (n = 5). In one case, the capsulated HCC was surrounded by a well-differentiated HCC component. The mean size of a HCC with a pseudocapsule tended to be smaller than that with histologic FC, although it was not significant (mean +/- standard deviation: 2.8 cm +/- 1.0 vs 3.5 cm +/- 2.0, P = .09). Liver cirrhosis was less frequent in HCCs with a pseudocapsule than in those with a histologic FC (one of 14 [7.1&#37;] vs 20 of 49 [40.8&#37;], P < .05). The tumor grades were not significantly different, and the incidence of vascular invasion after standardizing the tumor size (<= 4 cm) was similar (five of 14 [35.7&#37;] vs 12 of 37 [32.4&#37;]).
    Conclusion: Dynamic MR imaging is accurate in depicting FC in HCCs. HCC with a pseudocapsule at MR possibly consists of peritumoral sinusoids and/or fibrosis. The pseudocapsule may be similar to histologic FC in terms of tumor invasiveness. (C) RSNA, 2008

    DOI: 10.1148/radiol.2501071702

  • Diagnostic value of the delayed phase image for iso-attenuating pancreatic carcinomas in the pancreatic parenchymal phase on multidetector computed tomography Reviewed

    Kousei Ishigami, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Yoshiki Asayama, Akihiro Nishie, Masakazu Hirakawa, Yasuhiro Ushijima, Daisuke Okamoto, Shigenori Nagata, Yunosuke Nishihara, Koji Yamaguchi, Akinobu Taketomi, Hiroshi Honda

    EUROPEAN JOURNAL OF RADIOLOGY   69 ( 1 )   139 - 146   2009.1

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    Purpose: To assess the value of the delayed phase (DP) in pancreatic carcinomas which appear iso-attenuating in the pancreatic parenchymal phase (PPP).
    Materials and methods: Fifty-seven preoperative MDCT studies of pancreatic carcinomas were retrospectively reviewed. The size of the tumors, and the Hounsfield unit (HU) of the tumors and pancreatic parenchyma were measured. The tumor-to-pancreas contrast (TPC: vertical bar HU [tumor] - HU [normal pancreas]vertical bar) was calculated.
    Results: Eight cases (14.0&#37;) showed iso-attenuation and 49 showed hypo-attenuation in the PPP. The DP images revealed seven of eight (87.5&#37;) iso-attenuating tumors to be hyper-attenuating. The size of iso-attenuating tumors was smaller than that of hypo-attenuating tumors (mean +/- S.D.: 12.4 +/- 4.8 mm vs. 30.3 +/- 9.0 mm, p < 0.0001). In hypo-attenuating tumors, TPC in the PPP (60.2 +/- 24.6 HU) was higher than those in the portal venous phase (PVP, 40.5 +/- 23.0 HU, p < 0.0001) and DP (18.3 +/- 11.8 HU, in p < 0.0001). In contrast, in iso-attenuating tumors, TPC in the DP (26.0 +/- 14.9 HU) was higher than those in the PPP (9.2 +/- 3.7 HU, p = 0.0003) and PVP (7.1 +/- 4.7 HU, p = 0.001) phases.
    Conclusion: The DP image is helpful in depicting small iso-attenuating pancreatic carcinomas as slightly hyper-attenuating tumors. (C) 2007 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.ejrad.2007.09.012

  • Imaging of Intraductal Tubular Tumors of the Pancreas Reviewed

    Kousei Ishigami, Kengo Yoshimitsu, Hiroyuki Irie, Kenji Shinozaki, Shigenori Nagata, Koji Yamaguchi, Hiroshi Honda

    AMERICAN JOURNAL OF ROENTGENOLOGY   191 ( 6 )   1836 - 1840   2008.12

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    OBJECTIVE. The purpose of this study was to evaluate the imaging features of intraductal tubular tumors of the pancreas.
    CONCLUSION. Intraductal tubular tumors of the pancreas presented as solid tumors extending along and obstructing the pancreatic duct without downstream dilatation. Dynamic CT or MRI showed them to be hypovascular without delayed enhancement.

    DOI: 10.2214/AJR.07.4005

  • Significance of perivascular soft tissue around the common hepatic and proximal superior mesenteric arteries arising after pancreaticoduodenectomy: evaluation with serial MDCT studies Reviewed

    Kousei Ishigami, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Yoshiki Asayama, Masakazu Hirakawa, Daisuke Kakihara, Yoshiyuki Shioyama, Yunosuke Nishihara, Koji Yamaguchi, Hiroshi Honda

    ABDOMINAL IMAGING   33 ( 6 )   654 - 661   2008.11

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    Purpose: To evaluate the interval change of perivascular soft tissue (PVST) around the common hepatic and proximal superior mesenteric arteries arising after pancreaticoduodenectomy (PD) and to compare the difference between post operative change (benign PVST) and recurrence (malignant PVST).
    Materials and methods: Serial multidetector CT (MDCT) studies in 44 patients who underwent PD for periampullary carcinomas were retrospectively reviewed (Group A). The incidence and interval change of PVST were evaluated and compared to control group (Group B, 21 patients with PD for benign diseases).
    Results: PVST was seen in all the 44 patients in Group A, and it was noted in 12 of 21 (57.1&#37;) patients in Group B. Thirteen of 44 (29.5&#37;) patients showed interval enlargement of PVST (malignant PVST), and 12 of 13 developed within 2 years after PD. There was higher incidence of malignant PVST in patients with lymph node metastasis (p < 0.01) and those with pancreas head carcinoma (p < 0.05).
    Conclusion: PVST is common after PD regardless of whether patients had malignant or benign diseases. PVST should be monitored for at least 2 years to distinguish recurrence from post operative change. Patients with lymph node metastasis and pancreas head carcinoma had a higher incidence of malignant PVST.

    DOI: 10.1007/s00261-008-9359-9

  • Lesions Arising in or Involving the Iliopsoas Groove Reviewed

    Kousei Ishigami, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Yoshiki Asayama, Akihiro Nishie, Masakazu Hirakawa, Yasuhiro Ushijima, Daisuke Okamoto, Hiroshi Honda

    JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY   32 ( 6 )   975 - 981   2008.11

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    The purpose of this pictorial essay was to aid in the understanding of the anatomy of the iliopsoas groove by presenting imaging of various lesions affecting this region. Neurogenic tumors, lymphangiomas, lymphangioleimyomatosis, and posterior iliac crest lymph node metastases may present as masses in the iliopsoas groove. Iliopsoas abscess secondary to infections of the adjacent structures, tumors of the iliopsoas muscle, and iliopsoas hematomas may directly extend to this region.

    DOI: 10.1097/RCT.0b013e31815ade89

  • Noninvasive estimation of hepatic steatosis using plain CT vs. chemical-shift MR imaging: Significance for living donors Reviewed

    Kengo Yoshimitsu, Yousuke Kuroda, Makoto Nakamuta, Akinobu Taketomi, Hiroyuki Irie, Tsuyoshi Tajima, Masakazu Hirakawa, Kousei Ishigami, Yasuhiro Ushijima, Tomomi Yamada, Hiroshi Honda

    JOURNAL OF MAGNETIC RESONANCE IMAGING   28 ( 3 )   678 - 684   2008.9

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    Purpose: To compare plain computed tomography (CT) and chemical-shift MR imaging (CSI) for establishing a non-invasive method to estimate the degree of steatosis.
    Materials and Methods: A total of 58 patients who had histological proof of liver tissue and underwent CT and/or CSI within two weeks. were studied. They consisted of 38 living donor candidates and 20 liver surgery patients without hepatitis or cirrhosis. The CT index (CTI) and MR index (MRI) were defined and correlated to histological grades of steatosis. Correlation was also performed exclusively for mild steatosis (grades 0-2).
    Results: Both plain CT (p = 0.74, P < 0.0001) and CSI (p = 0.83. P < 0.0001) had good correlation with histological grades of steatosis. showing no significant difference between them. For mild steatosis. CSI (p = 0.77. P < 0.0001) had better correlation than CT (p = 0.49. P = 0.001) (P = 0.049). Accuracy in differentiation between grade 0-1 vs. grade 2-4 steatosis was 85&#37; using a CTI >6, and 91&#37; using an MRI <0.03 as criteria. That between grade 0-2 and grade 3-4 was 91&#37; using a CTI >-8 and 88&#37; using an MRI <0.25 as criteria.
    Conclusion: Both plain CT and CSI were useful in estimating the degree of steatosis but CSI was superior to CT in differentiating mild steatosis. These indices may at least partially replace percutaneous biopsy in evaluating grades of steatosis for living donors.

    DOI: 10.1002/jmri.21457

  • Retroperitoneal well-differentiated inflammatory liposarcoma: A diagnostic dilemma Reviewed

    Rinsaku Kawano, Akihiro Nishie, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Masakazu Hirakawa, Kousei Ishigami, Yasuhiro Ushijima, Daisuke Okamoto, Hidetake Yabuuchi, Akinobu Taketomi, Yunosuke Nishihara, Nobuhiro Fujita, Hiroshi Honda

    Radiation Medicine - Medical Imaging and Radiation Oncology   26 ( 7 )   450 - 453   2008.8

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    We present a case of retroperitoneal well-differentiated inflammatory liposarcoma that was extremely difficult to diagnose preoperatively. Computed tomography and magnetic resonance images showed a 5-cm homogeneous soft-tissue mass with a decreased apparent diffusion coefficient and without fat component in the retroperitoneum. Minimal fat stranding was detected around the mass. The preoperative working diagnosis was malignant lymphoma or inflammatory pseudotumor, whereas the final diagnosis after surgery was well-differentiated inflammatory liposarcoma. As a result, only a large component of lymphoid infiltration was recognized as a tumor preoperatively, and minimal fat stranding represented a component of lipoma-like liposarcoma. In this entity, a lipomatous component could easily be missed on radiologic imaging because of the conspicuity of lymphoid infiltration. We should consider the possibility of this variant when we evaluate a retroperitoneal tumor. © 2008 Japan Radiological Society.

    DOI: 10.1007/s11604-008-0255-6

  • Percutaneous transfemoral hepatic arterial infusion catheter placement with the use of a downsized coaxial catheter system: Technical feasibility study Reviewed

    Tsuyoshi Tajima, Kengo Yoshimitsu, Hiroyuki Irie, Akihiro Nishie, Masakazu Hirakawa, Kousei Ishigami, Yasuhiro Ushijima, Daisuke Okamoto, Munechika Kida, Rinya Kurogi, Hiroshi Honda, Toshirou Kuroiwa

    JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY   19 ( 8 )   1196 - 1201   2008.8

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    PURPOSE: In transfemoral implantation of a conventional port-catheter system for hepatic arterial infusion chemotherapy, there is a risk of pericatheter bleeding as a result of a caliber difference between the indwelling catheter and introducer sheath. The purpose of this study was to evaluate the feasibility and safety of a single-operator catheter exchange maneuver with a downsized system that includes a 3-F sheath.
    MATERIALS AND METHODS: Sixteen patients (15 men; mean age, 67 years) with unresectable liver cancer underwent percutaneous port-catheter placement. A system consisting of a 2-F microcatheter, 3.3-F diagnostic catheter, and 3-F sheath was used to perform mapping diagnostic visceral arteriography and microcoil embolization for redistribution of flow. Catheter exchange with a 5-F indwelling catheter (W-Spiral catheter) was performed, and the tip of a W-Spiral catheter was inserted into the right gastroepiploic artery. The technical success of this single-operator catheter exchange, postprocedural complications, and performance of one-step or multistep catheter exchange procedures were evaluated.
    RESULTS: Percutaneous port-catheter placement by a single operator with use of a downsized system was successful and safe in all patients (100&#37;). Eight of 16 patients (50&#37;) required multistep catheter exchange or dilation with two different guide wires because of arteriosclerosis, whereas the other eight underwent catheter exchange with a single guide wire.
    CONCLUSIONS: Percutaneous port-catheter placement with use of a downsized system offers potential clinical advantages of safety and simplified catheter exchange.

    DOI: 10.1016/j.jvir.2008.04.024

  • Retroperitoneal well-differentiated inflammatory liposarcoma: a diagnostic dilemma Reviewed

    Rinsaku Kawano, Akihiro Nishie, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Masakazu Hirakawa, Kousei Ishigami, Yasuhiro Ushijima, Daisuke Okamoto, Hidetake Yabuuchi, Akinobu Taketomi, Yunosuke Nishihara, Nobuhiro Fujita, Hiroshi Honda

    RADIATION MEDICINE   26 ( 7 )   450 - 453   2008.8

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    We present a case of retroperitoneal well-differentiated inflammatory liposarcoma that was extremely difficult to diagnose preoperatively. Computed tomography and magnetic resonance images showed a 5-cm homogeneous soft-tissue mass with a decreased apparent diffusion coefficient and without fat component in the retroperitoneum. Minimal fat stranding was detected around the mass. The preoperative working diagnosis was malignant lymphoma or inflammatory pseudotumor, whereas the final diagnosis after surgery was well-differentiated inflammatory liposarcoma. As a result, only a large component of lymphoid infiltration was recognized as a tumor preoperatively, and minimal fat stranding represented a component of lipoma-like liposarcoma. In this entity, a lipomatous component could easily be missed on radiologic imaging because of the conspicuity of lymphoid infiltration. We should consider the possibility of this variant when we evaluate a retroperitoneal tumor.

    DOI: 10.1007/s11604-008-0255-6

  • Microballoon occlusion test to predict colonic ischemia after transcatheter embolization of a ruptured aneurysm of the middle colic artery Reviewed

    Tsuyoshi Tajima, Kengo Yoshimitsu, Hiroyuki Inokuchi, Hiroyuki Irie, Akihiro Nishie, Masakazu Hirakawa, Kousei Ishigami, Yasuhiro Ushijima, Daisuke Okamoto, Hiroshi Honda, Hiroyuki Itoh, Masaru Morita, Yoshihiro Kakeji

    CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY   31 ( 4 )   828 - 832   2008.7

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    A 76-year-old woman presented with sudden massive melena, and superior mesenteric arteriography showed an aneurysm in the middle colic artery (MCA). Because she had a history of right hemicolectomy and ligation of the inferior mesenteric artery (IMA) during open abdominal aortic aneurysm repair, embolization of the MCA aneurysm was considered to pose a risk comparable to that of colonic ischemia. A microballoon occlusion test during occlusion of the MCA confirmed retrograde visualization of the IMA branches through the collateral arteries by way of the left internal iliac artery, and embolization was successfully performed using microcoils. No colonic ischemia or aneurysm rupture occurred after embolization.

    DOI: 10.1007/s00270-008-9330-8

  • Usefulness of apparent diffusion coefficient map in diagnosing prostate carcinoma: Correlation with stepwise histopathology Reviewed

    Kengo Yoshimitsu, Keijiro Kiyoshima, Hiroyuki Irie, Tsuyoshi Tajima, Yoshiki Asayama, Masakazu Hirakawa, Kousei Ishigami, Seiji Naito, Hiroshi Honda

    JOURNAL OF MAGNETIC RESONANCE IMAGING   27 ( 1 )   132 - 139   2008.1

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    Purpose: To elucidate the performance of apparent diffusion coefficient (ADC) map in localizing prostate carcinoma (PC) using stepwise histopathology as a reference.
    Materials and Methods: Preoperative MR images of 37 patients with PC who had undergone radical prostatectomy were retrospectively evaluated. First, T2-weighted images (T2WI) alone were interpreted (T2WI reading), and then T2WI along with ADC map were interpreted (T2WI/ ADC map reading). Sextant-based sensitivity and speci- ficity, and the ratio of the detected volume to the whole tumor volume (&#37; tumor volume) were compared between the two interpretations, and results were also correlated to Gleason's scores (GS). ADC values were correlated to histological grades.
    Results: Sensitivity was significantly higher in T2WI/ ADC map reading than in T2WI reading (71&#37; vs. 51&#37;), but specificity was similar (61&#37; vs. 60&#37;). By adding ADC map to T2WI, &#37; tumor volume detected increased significantly in transitional zone (TZ) lesions, but not in peripheral zone (PZ) lesions. &#37; tumor volume detected with T2WI/ADC map reading showed a positive correlation with GS of the specimens. Less differentiated PC were associated with lower ADC values and higher detectability.
    Conclusion: T2WI/ADC map reading was better than T2WI reading in PC detection and localization. This approach may be particularly useful for detecting TZ lesions and biologically aggressive lesions.

    DOI: 10.1002/jmri.21181

  • Radiologic detectability of minute portal venous invasion in hepatocellular carcinoma Reviewed

    Akihiro Nishie, Kengo Yoshimitsu, Yoshiki Asayama, Hiroyuki Irie, Tsuyoshi Tajima, Masakazu Hirakawa, Kousei Ishigami, Tomohiro Nakayama, Daisuke Kakihara, Yunosuke Nishihara, Akinobu Taketomi, Hiroshi Honda

    AMERICAN JOURNAL OF ROENTGENOLOGY   190 ( 1 )   81 - 87   2008.1

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    OBJECTIVE. The objective of this study was to evaluate whether minute portal venous invasion in hepatocellular carcinoma (HCC) can be diagnosed radiologically.
    MATERIALS AND METHODS. CT hepatic arteriography and CT with arterioportography ( CTAP) of 15 patients with minute portal venous invasion ( group 1) and 30 patients without it ( group 0) were evaluated. An area showing low attenuation on CTAP and high attenuation on CT hepatic arteriography around the tumor was defined as an area of peritumoral hemodynamic change. The shape and size of the area were compared between the two groups. The ratio of the area of peritumoral hemodynamic change volume to tumor volume ( area volume-tumor volume ratio) was used as an indicator of the size of the area of peritumoral hemodynamic change and was categorized as one of three grades: grade I, 10&#37; or less; grade II, between 10&#37; and 30&#37;; and grade III, 30&#37; or more. The detectability of minute portal invasion was assessed when grade III was considered as an indicator. Each comparison was also made independently when the tumor diameter either was limited to less than 3 cm or was 3 cm or more.
    RESULTS. Three types of area of peritumoral hemodynamic change were identified: wedge-shaped, belt-shaped or irregular, and linear. No significant difference in the frequency of each type of area of peritumoral hemodynamic change was observed between the two groups. The area volume-tumor volume ratio in group 1 was larger than that in group 0, with statistical significance when the tumor diameter was less than 3 cm ( p = 0.046). Positive and negative predictive values were 71.4&#37; and 75.0&#37;, respectively, when the tumor diameter was less than 3 cm.
    CONCLUSION. The area of peritumoral hemodynamic change in HCC patients with minute portal invasion ( group 1) may be larger than in those without it ( group 0), especially when tumors are small.

    DOI: 10.2214/AJR.07.2810

  • [Recent progress of diagnostic imaging in evaluating pancreaticobiliary malignancies]. Reviewed

    Irie H, Yoshimitsu K, Tajima T, Nishie A, Hirakawa M, Ishigami K, Ushijima Y, Okamoto D, Honda H

    Gan to kagaku ryoho. Cancer & chemotherapy   34 ( 9 )   1361 - 1364   2007.9

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    [Recent progress of diagnostic imaging in evaluating pancreaticobiliary malignancies].

  • Imaging Spectrum of Cystic Pancreatic Lesions: Learn from Atypical Cases Reviewed

    Hiroyuki Irie, Kengo Yoshimitsu, Tsuyoshi Tajima, Yoshiki Asayama, Masakazu Hirakawa, Kousei Ishigami, Yasuhiro Ushijima, Hiroshi Honda

    Current Problems in Diagnostic Radiology   36 ( 5 )   213 - 226   2007.9

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    The classic radiologic findings of cystic pancreatic masses have been well recognized
    however, diagnosing those lesions is still challenging since many cases show unusual radiologic findings. We reviewed the computed tomography, magnetic resonance, and endoscopic retrograde cholangiopancreatography findings of many pathologically proven cystic pancreatic masses and selected various atypical but instructive cases as well as rare pathologic cases from the past 10 years in our institution. This article presents atypical as well as rare pathologic cases of cystic pancreatic masses and correlates them with pathologic findings to obtain diagnostic clues to perform a correct diagnosis. © 2007 Mosby, Inc. All rights reserved.

    DOI: 10.1067/j.cpradiol.2007.03.001

  • Metastatic melanoma of the gallbladder Reviewed

    Yukihisa Takayama, Yoshiki Asayama, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Masakazu Hirakawa, Kousei Ishigarni, Daisuke Kakihara, Atsushi Sugitani, Yoichi Moroi, Takashi Eguchi, Hiroshi Honda

    COMPUTERIZED MEDICAL IMAGING AND GRAPHICS   31 ( 6 )   469 - 471   2007.9

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    We report the findings of a magnetic resonance (MR) imaging analysis of metastatic melanoma of the gallbladder in a 36-year-old woman. MR imaging revealed that the gallbladder wall was diffusely thickened, and the tumor showed slightly high-intensity on T1-weighted images. The apparent diffusion coefficient value of the tumor was 0.69 x 10(-3) mm(2)/s, indicating high cellularity. Surgical specimens revealed that the tumor was a metastatic melanoma showing medullary growth with intratumoral hemorrhaging. These MR findings are helpful for preoperative diagnosis. (c) 2007 Published by Elsevier Ltd.

    DOI: 10.1016/j.compmedimag.2007.03.005

  • Metastatic melanoma of the gallbladder Reviewed

    Yukihisa Takayama, Yoshiki Asayama, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Masakazu Hirakawa, Kousei Ishigarni, Daisuke Kakihara, Atsushi Sugitani, Yoichi Moroi, Takashi Eguchi, Hiroshi Honda

    COMPUTERIZED MEDICAL IMAGING AND GRAPHICS   31 ( 6 )   469 - 471   2007.9

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    We report the findings of a magnetic resonance (MR) imaging analysis of metastatic melanoma of the gallbladder in a 36-year-old woman. MR imaging revealed that the gallbladder wall was diffusely thickened, and the tumor showed slightly high-intensity on T1-weighted images. The apparent diffusion coefficient value of the tumor was 0.69 x 10(-3) mm(2)/s, indicating high cellularity. Surgical specimens revealed that the tumor was a metastatic melanoma showing medullary growth with intratumoral hemorrhaging. These MR findings are helpful for preoperative diagnosis. (c) 2007 Published by Elsevier Ltd.

    DOI: 10.1016/j.compmedimag.2007.03.005

  • Usefulness of the long-axis and short-axis reformatted images of multidetector-row CT in evaluating T-factor of the surgically resected pancreaticobiliary malignancies Reviewed

    Daisuke Kakihara, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Yoshiki Asayama, Masakazu Hirakawa, Kousei Ishigami, Koji Yamaguchi, Akinobu Taketomi, Yunosuke Nishihara, Hiroshi Honda

    EUROPEAN JOURNAL OF RADIOLOGY   63 ( 1 )   96 - 104   2007.7

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    Purpose: To evaluate the diagnostic efficacy of curved planar reformations along the duct (long-axis CPR) and series of reformations perpendicular to the duct (short-axis MPR) in evaluating T-factors of pancreaticobiliary malignancy.
    Materials and methods: Twenty-five patients with surgically proven pancreaticobiliary malignancy (12 bile duct cancers and 13 pancreas cancers) were evaluated. A dynamic study was performed with multidetector-row CT with four detectors, and reconstructed with 1 mm thickness and intervals. Tracing the center of the duct system on axial images, long-axis CPR images and serial short-axis MPR images were obtained. Two radiologists interpreted the T factor of the diseases three times: session (1), axial images only; session (2), axial, coronal and sagittal multiplanar reformation images; and session (3), axial, long-axis CPR, and short-axis MPR images. Receiver operating characteristic curves were analyzed.
    Results: In evaluations of bile duct cancer, Az values of (3) (0.95, 0.92) were higher than those of (1) (0.89, 0.88) and (2) (0.92, 0.89), with some significant differences. In evaluations of pancreas cancer, Az values of all interpretations were almost equal.
    Conclusion: Long-axis CPR and short-axis MPR images were suggested to be useful as additional images to the original axial images in evaluating the local extension of bile duct carcinomas. (c) 2007 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.ejrad.2007.01.022

  • Detection of the gonadal veins in the diagnosis of transposed ovaries in patients with cervical carcinoma: A useful sign on MDCT Reviewed

    Masakazu Hirakawa, Kengo Yoshimitsu, Daisuke Kakihara, Hiroyuki Irie, Yoshiki Asayayama, Kousei Ishigami, Hiroshi Honda

    AMERICAN JOURNAL OF ROENTGENOLOGY   188 ( 6 )   1564 - 1567   2007.6

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    OBJECTIVE. The purpose of our study was to evaluate the detectability of the gonadal vein of transposed ovaries in patients with uterine cervical cancer on MDCT.
    CONCLUSION. Gonadal veins and surgical clips of transposed ovaries can be shown with high consistency on MDCT. Tracking the gonadal veins and detecting the surgical clips may prevent the transposed ovaries from being misinterpreted as peritoneal implants.

    DOI: 10.2214/AJR.05.2032

  • Postgastrectomy development or accentuation of focal fatty change in segment IV of the liver - Correlation with the presence of aberrant venous branches of the parabiliary venous plexus Reviewed

    Kengo Yoshimitsu, Hiroyuki Irie, Daisuke Kakihara, Tsuyoshi Tajima, Yoshiki Asayama, Masakazu Hirakawa, Kousei Ishigami, Hirokazu Noshiro, Yoshihiro Kakeji, Hiroshi Honda

    JOURNAL OF CLINICAL GASTROENTEROLOGY   41 ( 5 )   507 - 512   2007.5

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    Background: Focal fatty change in segment IV (S4) of the liver is occasionally a diagnostic dilemma in the postoperative followup of gastric cancer patients. Goal: To determine whether development of focal fatty change in S4 is related to the presence of aberrant venous branches of the parabiliary venous plexus (PBP). Study: Two hundred seventy-six patients with gastrectomy who had been imaged by thin-slice preoperative computed tomography (CT) and at least one postoperative CT, and had no apparent liver masses were retrospectively analyzed. Preoperative CT were evaluated for the presence of aberrant venous branches of PBP entering S4. Serial postoperative CTs were evaluated for any interval change in the appearance of S4 of the liver. Results: There were 6 patients out of 276 (2&#37;) in whom focal fatty liver developed or accentuated after the surgery. In 5 out of the 6, preoperative CT demonstrated aberrant branches of PBP; 3 of these were suggested to be aberrant right gastric veins, and the etiologies were not determined in 2. In I case, no definite aberrant vessel was seen. Aberrant vessels were found in none of the remaining 270 patients. The incidence of aberrant vessels was significantly higher in patients who developed postoperative radiologic change in S4 than in those who did not (P < 0.0001). Conclusions: Development or accentuation of focal fatty liver in S4 of the liver was observed in 2&#37; of postgastrectomy patients and was closely related to the presence of aberrant venous branches of PBP.

    DOI: 10.1097/01.mcg.0000225613.86846.cb

  • Significance of mesenteric lymphadenopathy after pancreaticoduodenectomy for periampullary carcinomas: Evaluation with serial MDCT studies Reviewed

    Kousei Ishigami, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Yoshiki Asayama, Masakazu Hirakawa, Daisuke Kakihara, Yoshiyuki Shioyama, Yunosuke Nishihara, Koji Yamaguchi, Hiroshi Honda

    EUROPEAN JOURNAL OF RADIOLOGY   61 ( 3 )   491 - 498   2007.3

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    Objective: To evaluate the significance of mesenteric lymphadenopathy arising after pancreaticoduodenectomy (PD) for periampullary carcinomas.
    Materials and methods: Serial multidetector CT (MDCT) studies in 44 patients after PD for periampullary carcinomas (Group A) were retrospectively reviewed, the incidence and interval changes of mesenteric lymphadenopathy were evaluated, and comparisons were made with 21 patients who underwent PD for benign diseases (Group B).
    Results: In Group A, mesenteric lymphadenopathy was seen in 31 of 44 (70.5&#37;) patients. The short axis diameter of the largest lymph node ranged from 6.2 to 11.5 mm (mean +/- S.D.: 8.6 +/- 1.4 mm), and the short-axis-to-long-axis (S/L) ratio ranged from 0.46 to 0.99 (mean +/- S.D.: 0.69 +/- 0.12). Six of the 31 (19.4&#37;) mesenteric lymphadenopathy cases showed interval increases in size on follow-up studies, and three cases showed new development of mesenteric lymphadenopathy: all of these nine cases had concurrent recurrence in the mesenteric root. In Group B, 11 (52.4&#37;) had mesenteric lymphadenopathy. The short axis diameter of the largest lymph node ranged from 5.6 to 10.9 mm (mean +/- S.D.: 8.0 +/- 1.9 mm) and the S/L ratio ranged from 0.48 to 0.93 (mean +/- S.D.: 0.67 +/- 0.12). Differences in the incidence, short axis diameter and S/L ratio were not significant between Groups A and B (p = 0.154, 0.271 and 0.654, respectively).
    Conclusion: Mesenetric lymphadenopathy after PD less likely reflects recurrence. Lymph node metastasis may be suggested only when coexisting recurrent mass is found in the proximal mesenteric root. (C) 2006 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.ejrad.2006.10.008

  • Gadolinium-enhanced fat-suppressed T1-weighted imaging for staging ureteral carcinoma: Correlation with histopathology Reviewed

    Masao Obuchi, Kousei Ishigami, Koji Takahashi, Minoru Honda, Toshiyuki Mitsuya, David M. Kuehn, Alan H. Stolpen, Bruce P. Brown, Akihiro Nishie

    AMERICAN JOURNAL OF ROENTGENOLOGY   188 ( 3 )   W256 - W261   2007.3

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    OBJECTIVE. The purpose of this study was to retrospectively compare contrast-enhanced fat-suppressed T1-weighted images with histopathologic findings in ureteral carcinoma to develop accurate preoperative MR criteria for T staging.
    CONCLUSION. Contrast-enhanced fat-suppressed T1-weighted images can be used to distinguish thickened noncarcinomatous ureteral walls, which occur due to the proliferation of fibrous tissue, from ureteral carcinoma because fibrous tissue enhances more intensely on MRI than ureteral carcinoma. We also observed that when ureteral carcinomas had invaded periureteral fat tissue, a disruption or fragmentation of the intensely enhancing ureteral wall was seen. Using the MR criteria for T staging that we developed on the basis of these findings, we were able to accurately determine whether a carcinoma had invaded periureteral fat tissue in all of our patients.

    DOI: 10.2214/AJR.05.0172

  • Gliomatosis peritonei associated with immature ovarian teratoma: A mimicker of peritoneal dissemination of malignant diseases Reviewed

    Daisuke Okamoto, Kousei Ishigami, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Yoshiki Asayama, Masakazu Hirakawa, Yasuhiro Ushijima, Yunosuke Nishihara, Satoshi Amada, Hiroaki Kobayashi, Hiroshi Honda

    JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY   31 ( 2 )   317 - 319   2007.3

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    A rare case of gliomatosis peritonei associated with immature ovarian teratoma was reported. The computed tomographic findings of gliomatosis peritonei were similar to the classic findings of peritoneal dissemination of malignant tumors. To avoid overestimating the clinical stage of ovarian tumors, radiologists should be aware of this rare condition related to teratomas.

    DOI: 10.1097/01.rct.0000250111.87585.55

  • Poorly versus moderately differentiated hepatocellular carcinoma: Vascularity assessment by computed tomographic hepatic angiography in correlation with histologically counted number of unpaired arteries Reviewed

    Yoshiki Asayama, Kengo Yoshimitsu, Hiroyuki Irie, Yunosuke Nishihara, Shinichi Aishima, Tsuyoshi Tajima, Masakazu Hirakawa, Kousei Ishigami, Daisuke Kakihara, Akinobu Taketomi, Hiroshi Honda

    JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY   31 ( 2 )   188 - 192   2007.3

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    Purpose: To determine the vascularity of moderately and poorly differentiated hepatocellular carcinoma (mHCC and pHCC, respectively) as observed on and depicted by computed tomography during hepatic angiography and to perform pathological correlation.
    Materials and Methods: Eighty-seven consecutive patients with 89 hepatocellular carcinomas (61 mHCCs and 28 pHCCs) were surgically resected in our hospital. The degree of contrast enhancement on computed tomography during hepatic angiography of the tumors was classified into high attenuation (H), isoattenuation (I), and low attenuation (Q. We also examined hepatocellular carcinomas measuring less than 4 cm in diameter. Pathologically, the number of impaired arteries in the tumors was determined (x 200 magnification).
    Results: The number of mHCC and pHCC in each degree of enhancement (H/I/L) was 59:1:1 and 19:63, respectively. The number of mHCC and pHCC measuring less than 4 cm without portal invasion was 48 and 15, respectively; the number of these tumors in each degree of enhancement (H/I/L) was 47:1:0 and 11:3:1, respectively. The mean number of unpaired arteries was 8.9 +/- 4.4 in mHCC and 5.2 +/- 4.3 in pHCC, respectively. All results were statistically significant (P < 0.01).
    Conclusions: Our results indicated that the arterial blood supply of pHCC was lower than that of mHCC.

    DOI: 10.1097/01.rct.0000236417.82395.57

  • Three cases of serous oligocystic adenomas of the pancreas; Evaluation of cyst wall thickness for preoperative differentiation from mucinous cystic neoplasms Reviewed

    Hiroshi Yamaguchi, Kousei Ishigami, Takahiro Inoue, Takashi Eguchi, Shigenori Nagata, Yosuke Kuroda, Yunosuke Nishihara, Koji Yamaguchi, Masao Tanaka, Masazumi Tsuneyoshi

    Journal of Gastrointestinal Cancer   38 ( 1 )   52 - 58   2007.1

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    Background: Serous oligocystic adenoma (SOA), a rare pancreatic neoplasm, is generally a benign lesion without the necessity of surgery. Preoperatively, it is difficult to discriminate SOA from mucinous cystic neoplasm (MCN), which essentially needs surgical treatment. The purpose of this study was to evaluate the cyst wall thickness of SOAs and MCNs for preoperative differential diagnosis. Methods: We experienced three cases of SOAs with typical histopathological features. The cyst wall thickness of the SOAs was evaluated in the area protruding out of the pancreas and was compared with that of 13 MCNs histopathologically. The same evaluation and comparison were conducted on preoperative computed tomography (CT) images retrospectively. Results: The SOAs had a uniformly thin cyst wall measuring less than 1 mm. In contrast, the largest area of a cyst wall in MCNs ranged from 2.5 to 10.0 mm. On CT images, all but one of the MCNs showed a detectable cyst wall, while the cyst walls were hardly recognizable in two of the three SOAs. Conclusions: For preoperative differentiation between SOAs and MCNs, the evaluation of cyst wall thickness may be an important tool and may contribute to the decision of treatment strategy. © 2008 Humana Press Inc.

    DOI: 10.1007/s12029-008-9017-z

  • [MDCT of pancreatic disorders]. Reviewed

    Irie H, Yoshimitsu K, Ishigami K, Tajima T, Asayama Y, Hirakawa M, Ushijima Y, Honda H

    Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology   103 ( 12 )   1333 - 1338   2006.12

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    [MDCT of pancreatic disorders].

    DOI: 10.11405/nisshoshi.103.1333

  • Arterial steroid injection therapy can inhibit the progression of severe acute hepatic failure toward fulminant liver failure Reviewed

    Kazuhiro Kotoh, Munechika Enjoji, Makoto Nakamuta, Tsuyoshi Yoshimoto, Motoyuki Kohjima, Shusuke Morizono, Shinsaku Yamashita, Yuki Horikawa, Kengo Yoshimitsu, Tsuyoshi Tajima, Yoshiki Asayama, Kousei Ishigami, Masakazu Hirakawa

    WORLD JOURNAL OF GASTROENTEROLOGY   12 ( 41 )   6678 - 6682   2006.11

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    AIM: To utilize transcatheter arterial steroid injection therapy (TASIT) via the hepatic artery to reduce hepatic macrophage activity in patients with severe acute hepatic failure.
    METHODS: Thirty-four patients with severe acute hepatic failure were admitted to our hospital between June 2002 to June 2006 providing for the possibility of liver transplantation (LT). Seventeen patients were treated using traditional liver supportive procedures, and the other 17 patients additionally underwent TASIT with 1000 mg methylprednisolone per day for 3 continuous days.
    RESULTS: Of the 17 patients who received TASIT, 13 were cured without any complications, 2 died, and 2 underwent LT. Of the 17 patients who did not receive TASIT, 4 were self-limiting, 7 died, and 6 underwent LT. Univariate logistic analysis revealed that ascites, serum albumin, prothrombin time, platelet count, and TASIT were significant variables for predicating the prognosis. Multivariate logistic regression analysis using stepwise variable selection showed that prothrombin time, platelet count, and TASIT were independent predictive factors.
    CONCLUSION: TASIT might effectively prevent the progression of severe acute hepatic failure to a fatal stage of fulminant liver failure. (C) 2006 The WJG Press. All rights reserved.

  • Accessory left gastric artery from left hepatic artery shown on MDCT and conventional angiography: Correlation with CT hepatic arteriography Reviewed

    Kousei Ishigami, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Yoshiki Asayama, Masakazu Hirakawa, Hiroshi Honda

    AMERICAN JOURNAL OF ROENTGENOLOGY   187 ( 4 )   1002 - 1009   2006.10

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    OBJECTIVE. The objective of our study was to evaluate the diagnostic accuracy of MDCT and conventional angiography in the detection of an accessory left gastric artery using CT hepatic arteriography as the standard of reference.
    MATERIALS AND METHODS. The study group consisted of 118 patients who underwent MDCT with a triple-phase liver protocol with a slice thickness of 5 nun, conventional angiography, and CT hepatic arteriography. The early-phase images of MDCT and conventional angiography were retrospectively reviewed. The presence or absence of an accessory left gastric artery was evaluated using CT hepatic arteriography as the standard of reference. The sensitivity, specificity, and accuracy of MDCT and conventional angiography were calculated.
    RESULTS. CT hepatic arteriography revealed an accessory left gastric artery in 25 (21.2&#37;) of 118 cases, including 15 proximal- and 10 distal-type accessory left gastric arteries. On MDCT, there were seven false-negative cases and one false-positive case. Six of the seven false-negative cases were a proximal-type accessory left gastric artery, and nine of 10 distal-type accessory left gastric arteries were correctly diagnosed using MDCT. The sensitivity, specificity, and accuracy of MDCT were 72.0&#37;,98.9&#37;, and 93.2&#37;, respectively. On conventional angiography, there were three false-negative and two false-positive cases, none of whom underwent selective left hepatic arteriography. Two of the three false-negative cases were the distal-type accessory left gastric artery, but eight of the 10 distal-type accessory left gastric arteries were correctly diagnosed. The sensitivity, specificity, and accuracy of conventional angiography were 88.0&#37;, 97.8&#37;, and 95.8&#37;, respectively.
    CONCLUSION. Approximately 70&#37; of accessory left gastric arteries can be diagnosed at the early phase of MDCT even with a slice thickness of 5 mm.

    DOI: 10.2214/AJR.05.1114

  • Posterior iliac crest lymph node metastasis from ovarian cancer 15 years after surgery: a mimicker of primary retroperitoneal tumor Reviewed

    Makoto Shinoto, Kousei Ishigami, Kengo Yoshimitsu, Satoshi Amada, Hiroshi Honda

    EUROPEAN RADIOLOGY   16 ( 9 )   2126 - 2127   2006.9

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    DOI: 10.1007/s00330-006-0167-8

  • Hepatocellular carcinoma with a prominent vascular scar in the center: MR imaging findings Reviewed

    Madoka Yamauchi, Yoshiki Asayama, Kengo Yoshimitsu, Hiroyuki Irie, Tsuyoshi Tajima, Masakazu Hirakawa, Kousei Ishigami, Tomohiro Nakayama, Daisuke Kakihara, Koji Yamaguchi, Yunosuke Nishihara, Shinichi Aishima, Hiroshi Honda

    Radiation Medicine - Medical Imaging and Radiation Oncology   24 ( 6 )   467 - 470   2006.7

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    We report herein a case of hepatocellular carcinoma (HCC) with a prominent central scar. Dynamic CT and MRI studies revealed a hypervascular liver mass and a washout of contrast material in the delayed phase. The tumor center showed particular hyperintensity on T2-weighted images and delayed or prolonged enhancement. The surgical specimen revealed moderately differentiated HCC with a central scar. The central scar consisted of prominent vascular channels and loose fibrous tissue, indicative of a vascular scar. We should understand MR imaging findings of this type of central scar in the HCC. © Japan Radiological Society 2006.

    DOI: 10.1007/s11604-006-0052-z

  • The incidence of hepatic pseudolesions caused by focal rib compression as seen on multidetector row CT in patients of different hepatic function Reviewed

    A Nishie, K Yoshimitsu, H Irie, H Aibe, T Tajima, Y Asayama, K Matake, K Ishigami, T Nakayama, D Kakihara, H Honda

    EUROPEAN JOURNAL OF RADIOLOGY   57 ( 1 )   108 - 114   2006.1

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    Objective: To determine whether the incidence of pseudolesions of the liver caused by rib compression is correlated with liver function.
    Materials and methods: Multidetector row CT images of 150 consecutive cases were evaluated for the presence of pseudolesions caused by rib compression. Liver function was categorized into two groups mainly using the Child-Pugh classification: Group I-normal liver function and Grade A; Group II-Grades B and C. The number of focal deformities of the liver caused by rib compression was also counted. The incidence of pseudolesions based on number of patients or focal deformities of liver parenchyma by rib compression were compared between the two groups.
    Results: There were 108 and 42 patients in Groups I and II, respectively. 169 and 41 focal deformities of the liver caused by rib compression were found in Groups I and 11, respectively. Patient-based and deformity-based incidences of pseudolesions were 10.7&#37; (16/150) and 7.6&#37; (16/210), respectively. All pseudolesions were seen in patients of Group I. Both patient-based and deformity-based incidences of pseudolesions were significantly higher in Group I as compared with those in Group II.
    Conclusion: Pseudolesions of the liver caused by focal rib compression may be seen more frequently in patients with preserved liver function than in those with impaired function. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.ejrad.2005.08.013

  • Tubular ectasia of the epididymis: A sign of postvasectomy status Reviewed

    K Ishigami, MM Abu-Yousef, Y El-Zein

    JOURNAL OF CLINICAL ULTRASOUND   33 ( 9 )   447 - 451   2005.12

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    Purpose. To find out if "tubular ectasia of the epididymis" is suggestive of postvasectomy status.
    Methods. Tubular ectasia of the epididymis is defined as enlargement of the epididymis with multiple inter-faces (i.e., a speckled appearance). We found 24 cases exhibiting tubular ectasia of the epididymis over a period of six years. We reviewed the sonographic findings of tubular ectasia of the epididymis and evaluated the prevalence of associated findings.
    Results. In 24 patients with tubular ectasia of the epididymis, 16 cases were bilateral, five were right-sided, and three were left-sided. Twenty-one patients had history of vasectomy, of the three remaining cases, 1 had history of inguinal hernia repair, one had prostatitis, and one had undetermined etiology. Associated abnormalities included dilated vas deferens (n = 4), tubular ectasia of the testis (n = 2), large spermato-celes (n = 6), hydrocele (n 3), and varicocele (n = 4). In 2 cases, spermatic granulomas were suspected.
    Conclusion. Tubular ectasia of the epididymis is suggestive of postvasectomy epididymis. This sonographic feature is helpful in evaluating a patient with scrotal discomfort. However, this sign can also be associated with other causes of vas obstruction. (c) 2005 Wiley Periodicals, Inc.

    DOI: 10.1002/jcu.20162

  • Diagnostic value of gadolinium-enhanced 3D magnetic resonance angiography in patients with suspected hepatic arterial complications after liver transplantation Reviewed

    K Ishigami, AH Stolpen, FMH Al-kass, Y Zhang, SC Rayhill, DA Katz, M Abu-Yousef

    JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY   29 ( 4 )   464 - 471   2005.7

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    Purpose: To evaluate the accuracy and clinical role of gadolinium-enhanced 3D magnetic resonance angiography (MRA) in patients with suspected hepatic arterial complications after liver transplantation.
    Materials and Methods: Thirty-six consecutive MRA studies were performed in 33 liver transplant recipients after transplantation. MRA image quality was assessed subjectively. Thirty-two MRA studies were retrospectively reviewed and correlated with surgery (n = 2), conventional angiography (n = 18), or clinical follow-up (n = 12). MRA findings were also correlated with those of Doppler sonography in 30 of the cases. In 20 cases, concordance between MRA and surgery or conventional angiography was evaluated for each grade of hepatic artery stenosis (normal, mild [< 50&#37;], moderate [50-75&#37;], severe [> 75&#37;], or occluded).
    Results: MRA image quality was degraded 13 of 36 cases (36.1&#37;) studies. The sensitivity, specificity, and accuracy of MRA by consensus reading for more than 50&#37; of hepatic artery stenosis or occlusion were 67&#37;, 90&#37;, and 81.3&#37;, respectively. Of the 19 cases in which Doppler sonography was abnormal, MRA correctly characterized hepatic artery stenosis in 16 (84.2&#37;). MRA also correctly identified all 5 occurrences of celiac artery stenosis. However, MRA overestimated the severity of hepatic arterial stenosis in 3 (15&#37;) of 20 cases and underestimated 5 (25&#37;) of 20 cases.
    Conclusion: MRA complements Doppler ultrasound to exclude significant hepatic artery stenosis. However, a substantial number of MRA studies were technically inadequate, and MRA demonstrated limited efficacy for correctly grading the severity of hepatic artery stenosis.

    DOI: 10.1097/01.rct.0000164258.52212.4c

  • Correlation of preoperative three-dimensional magnetic resonance angiography with intraoperative findings in laparoscopic renal surgery Reviewed

    DS Wang, AH Stolpen, VG Bird, K Ishigami, SC Rayhill, HN Winfield

    JOURNAL OF ENDOUROLOGY   19 ( 2 )   193 - 199   2005.3

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    Background and Purpose: Contrast-enhanced three-dimensional magnetic resonance angiography (3D-MRA) with image reconstruction has important applications in laparoscopic urologic surgery. We now use 3D-MRA as part of our preoperative evaluation in selected patients undergoing laparoscopic donor nephrectomy, pyelo-plasty, radical nephrectomy, and partial nephrectomy.
    Patients and Methods: From June 2001 to December 2002, 50 patients underwent preoperative 3D-MRA at 1.5 T prior to laparoscopic renal surgery. In general, preoperative 3D-MRA was obtained for donor nephrectomies and pyeloplasties and for cases where prior imaging suggested a possible vascular anomaly. Patients who underwent preoperative imaging included those having donor nephrectomy (N = 28), pyeloplasty (N = 12), radical nephrectomy (N = 5), partial nephrectomy (N = 3), and other laparoscopic renal procedures (N = 2). The 3D-MRA studies were interpreted by one radiologist, and all laparoscopic cases were performed by one of two surgeons. The findings of 3D-MRA were correlated with the intraoperative findings with special attention to aberrant vasculature, including duplicated renal arteries or veins, accessory vessels, or crossing vessels.
    Results: Among patients undergoing laparoscopic donor nephrectomy, 3D-MRA correctly predicted the number of renal vessels in 27 of 28 cases (96&#37;), including all 3 cases of left retroaortic renal vein. Also, 3D-MRA correctly predicted the presence or absence of a crossing vessel in 10 of 12 cases (83&#37;) of laparoscopic pyeloplasty. The imaging study also correctly predicted the number of hilar vessels in all five cases of radical nephrectomy, all three cases of partial nephrectomy, and both cases of other renal operations. Overall, 3D-MRA correctly defined the renal hilar anatomy in 48 of 50 patients, for an overall accuracy of 96&#37;.
    Conclusions: Three-dimensional MRA findings correlate well (96&#37;) with intraoperative findings in laparoscopic renal surgery. The imaging study provides exquisite vascular detail and is highly accurate, making it sufficient imaging prior to laparoscopic donor nephrectomy and useful for pyeloplasty and other complex renal operations.

    DOI: 10.1089/end.2005.19.193

  • Necrotizing fasciitis caused by xanthogranulomatous and emphysematous pyelonephritis: Importance of the inferior lumbar triangle pathway Reviewed

    K Ishigami, JA Bolton-Smith, BR DeYoung, TJ Barloon

    AMERICAN JOURNAL OF ROENTGENOLOGY   183 ( 6 )   1708 - 1710   2004.12

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    DOI: 10.2214/ajr.183.6.01831708

  • Does variant hepatic artery anatomy in a liver transplant recipient increase the risk of hepatic artery complications after transplantation? Reviewed

    K Ishigami, Y Zhang, S Rayhill, D Katz, A Stolpen

    AMERICAN JOURNAL OF ROENTGENOLOGY   183 ( 6 )   1577 - 1584   2004.12

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    OBJECTIVE. Our aim was to determine whether variant hepatic artery anatomy in a liver transplant recipient increases the risk of hepatic artery complications after liver transplantation.
    MATERIALS AND METHODS. The study group consisted of 84 patients who underwent gadolinium-enhanced 3D MR angiography before orthotopic liver transplantation in which a branch patch arterial anastomosis at the gastroduodenal takeoff was used. MR angiography studies were retrospectively reviewed and assessed for the presence and type of variant hepatic artery anatomy. The diameter of the distal common hepatic artery was measured. The incidence of posttransplantation hepatic artery stenosis or thrombosis was assessed.
    RESULTS. Seven (8.3&#37;) of the 84 patients developed hepatic artery complications after transplantation. Of the 24 patients with variant hepatic artery anatomy, five (20.8&#37;) had posttransplantation hepatic artery complications. In contrast, only two (3.3&#37;) of the 60 patients with classic hepatic artery anatomy had complications. The higher complication rate in patients with variant hepatic artery anatomy was statistically significant (p<0.05). The odds ratio was 7.6 (95&#37; confidence interval, 1.4-42.6). The diameter of the distal common hepatic artery was smaller in patients with variant hepatic artery anatomy compared with those with classic hepatic artery anatomy (range, 4.3-7.1 mm [mean, 5.8 nun] vs 4.0-8.9 mm [mean 6.3 mm], p<0.05), and it was also smaller in patients who had posttransplantation hepatic artery complications compared with those who had no complications (range, 4.2-6.3 mm [mean, 5.2 mm] vs 4.0-8.9 mm, [mean, 6.2 nun], p<0.01).
    CONCLUSION. Variant hepatic artery anatomy in a liver transplant recipient increased the risk of hepatic artery complications after transplantation. The smaller caliber of the native common hepatic artery may contribute to the higher risk.

    DOI: 10.2214/ajr.183.6.01831577

  • Adrenal adenoma with organizing hematoma: diagnostic dilemma at MRI Reviewed

    K Ishigami, AH Stolpen, Y Sato, L Dahmoush, HN Winfield, LL Fajardo

    MAGNETIC RESONANCE IMAGING   22 ( 8 )   1157 - 1159   2004.10

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    We report a case of adrenal adenoma with organizing hematoma mimicking hemangioma on magnetic resonance imaging (MRI). The lesion demonstrated heterogeneous hyperintensity on heavily T2-weighted images. On dynamic contrasted-enhanced MRI, the lesion demonstrated early, patchy peripheral enhancement with subsequent fill-in that persisted. Chemical shift gradient-echo images failed to demonstrate the presence of intracellular lipid. Magnetic resonance imaging failed to characterize the lesion, and an erroneous preoperative diagnosis of adrenal hemangioma was made. Although the MRI findings reflected the organized hematoma with abundant vascular spaces, our case emphasizes the point that the MRI characteristics of intratumoral hemorrhage may overlap with those of adrenal hemangioma and chronic expanding hematoma. (C) 2004 Elsevier Inc. All rights reserved.

    DOI: 10.1016/j.mri.2004.03.001

  • Liver lesions of visceral larva migrans due to Ascaris suum infection: CT findings Reviewed

    D Kakihara, K Yoshimitsu, K Ishigami, H Irie, H Aibe, T Tajima, K Shinozaki, A Nishie, T Nakayama, K Hayashida, M Nakamuta, H Nawata, H Honda

    ABDOMINAL IMAGING   29 ( 5 )   598 - 602   2004.9

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    The purpose of this study was to analyze computed tomographic (CT) findings of hepatic lesions due to Ascaris suum infection. CT of the liver in three patients, all of whom had immunoserologically confirmed A. suum infection, were retrospectively reviewed. Twenty-five lesions were identified in total. Two radiologists analyzed CT findings in a consensus fashion, with particular interest in the margin, shape, and location of the lesions. Hepatic lesions were ill-defined (22 of 25), small (3-35 mm; average, 11 mm), and nodular (18 of 25) or wedge (three of 25) in shape. Most were locate in periportal (16 of 25) or subcapsular (six of 25) regions. Hepatic nodules due to visceral larva migrans of A. suum were located mainly in periportal or subcapsular regions, which may represent the pathophysiology of this entity.

    DOI: 10.1007/s00261-003-0153-4

  • Enlargement and hypervascularity of both the epididymis and testis do not exclude involvement with lymphoma or leukemia Reviewed

    K Ishigami, DM Yousef-Zahra, MM Abu-Yousef

    JOURNAL OF CLINICAL ULTRASOUND   32 ( 7 )   365 - 369   2004.9

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    We present 3 cases of diffuse infiltration of the testes and epididymides by malignant lymphoma and leukemia. Gray-scale and color Doppler sonograms showed diffuse hypoechoic enlargement and hypervascularity of the involved testes and epididymides. The authors emphasize that enlargement and hypervascularity of both the epididymis and testis can be caused by lymphomatous/leukemic involvement and is not always indicative of epididymo-orchitis. (C) 2004 Wiley Periodicals, Inc.

    DOI: 10.1002/jcu.20046

  • Imaging of an accessory spleen presenting as a slow-growing mass in the transplanted pancreas Reviewed

    K Ishigami, B Hammett, M Obuchi, D Katz, S Rayhill, A Fathala, M Abu-Yousef

    AMERICAN JOURNAL OF ROENTGENOLOGY   183 ( 2 )   405 - 407   2004.8

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    DOI: 10.2214/ajr.183.2.1830405

  • Portal vein occlusion with aberrant left gastric vein functioning as a hepatopetal collateral pathway Reviewed

    K Ishigami, S Sun, MJ Berst, SD Heery, LL Fajardo

    JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY   15 ( 5 )   501 - 504   2004.5

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    A rare case of an aberrant left gastric vein functioning as a hepatopetal collateral as a result of portal vein occlusion is presented herein. The portal venous phase of multislice computed tomography clearly demonstrated this anatomic variation and provided a reliable vascular "road map" for percutaneous transhepatic portal venous stent placement. Portal hypertension associated with extensive gastrojejunal varices improved dramatically after stent placement.

    DOI: 10.1097/01.RVI.0000126810.67111.CA

  • Intravascular gas in the transplanted kidney: a sign of extensive graft necrosis. Reviewed

    Ishigami K, Olsen KM, Hammet BK, Katz DA, Wu YM

    Emergency radiology   10 ( 5 )   279 - 281   2004.4

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    Intravascular gas in the transplanted kidney: a sign of extensive graft necrosis.

    DOI: 10.1007/s10140-004-0334-7

  • Gas-forming abdominal wall abscess: unusual manifestation of perforated retroperitoneal appendicitis extending through the superior lumbar triangle. Reviewed

    Ishigami K, Khanna G, Samuel I, Dahmoush L, Sato Y

    Emergency radiology   10 ( 4 )   207 - 209   2004.2

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    Gas-forming abdominal wall abscess: unusual manifestation of perforated retroperitoneal appendicitis extending through the superior lumbar triangle.

    DOI: 10.1007/s10140-003-0314-3

  • Ruptured splenic abscess: a cause of pneumoperitoneum in a patient with AIDS. Reviewed

    Ishigami K, Decker GT, Bolton-Smith JA, Samuel I, Wilson SR, Brown BP

    Emergency radiology   10 ( 3 )   163 - 165   2003.12

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    Ruptured splenic abscess: a cause of pneumoperitoneum in a patient with AIDS.

    DOI: 10.1007/s10140-003-0302-7

  • Effects of aging on muscle T2 relaxation time - Difference between fast- and slow-twitch muscles Reviewed

    M Hatakenaka, M Ueda, K Ishigami, M Otsuka, K Masuda

    INVESTIGATIVE RADIOLOGY   36 ( 12 )   692 - 698   2001.12

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    RATIONALE AND OBJECTIVES. To determine whether the T2 relaxation time of skeletal muscle is affected by aging and to compare the effects of aging between fast- and slow-twitch muscles in a human study. To investigate the mechanisms of age-related changes in T2 relaxation time in an animal (mouse) study.
    METHODS. T2 relaxation times of the soleus (slow-twitch, rich in type I fiber) and gastrocnemius (fast-twitch, rich in type II fiber) muscles were examined in 59 healthy human subjects, 22 to 76 years of age, by clinical magnetic resonance imaging. In mice, T2 relaxation times, fat ratios, and extracellular space ratios (extracellular space/intracellular plus extracellular space) of the spinalis (fast-twitch, rich in type II fiber) muscles were also examined (group of 7 old mice, 24-26 months; group of 7 young mice, 8-10 weeks).
    RESULTS. In the human study, the T2 relaxation time of the gastrocnemius muscle increased significantly with aging (r = 0.53, P < 0.01) while that of the soleus muscle did not. In the animal study, the T2 relaxation time of the spinalis muscle was significantly longer (P < 0.05) and the extracellular space ratio of the spinalis muscle significantly wider (P < 0.01) in old than in young mice. No significant difference in fat ratio was observed between old and young mice. A significant, positive correlation was seen between the extracellular space ratio and T2 relaxation time (r = 0.84, P < 0.01).
    CONCLUSIONS. The T2 relaxation time of fast-twitch muscle increases with aging, due mainly to increased extracellular space, reflecting age-related type II fiber atrophy.

    DOI: 10.1097/00004424-200112000-00003

  • Expression of the c-myc end c-fos genes as a potential indicator of late radiation damage to the kidney Reviewed

    M Otsuka, M Hatakenaka, K Ishigami, K Masuda

    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS   49 ( 1 )   169 - 173   2001.1

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    Purpose: To evaluate proliferative response according to c-myc and c-fos gene expression as an early indicator of late radiation damage to the kidney.
    Methods and Materials: c-myc and c-fos gene expression was measured in the irradiated kidney of C3H/HeSlc mice using reverse transcriptase-polymerase chain reaction (RT-PCR) 24 h after 9, 12, and 15 Gy as well as 2 and 7 days after 15 Gy, In a second experiment, 12 Gy was administered to the right kidney plus the lower half of left kidney. The mice underwent left nephrectomy 24 h after, and the correlation between increased gene expression and elevation of the blood urea nitrogen (BUN) level representing late functional damage was investigated.
    Results: c-myc and c-fos expression increased in 1 of 10 controls and in 8 of 10 and 7 of 10 mice that received 15 Gy, respectively. Expression increased dose-dependently from 9 to 15 Gy, In mice having an increased BUN level, 7 of 10 and 8 of 10 were positive for c-myc and c-fos, respectively, All 6 mice having an unchanged BUN level were negative for e-fos, while 5 were negative for c-myc.
    Conclusion: Measurement of c-myc and c-fos gene expression is potentially an early indicator of late radiation damage to the kidney. (C) 2001 Elsevier Science Inc.

    DOI: 10.1016/S0360-3016(00)01371-7

  • Coil embolization of arterioportal fistula that developed after partial gastrectomy Reviewed

    K Ishigami, K Yoshimitsu, H Honda, T Kuroiwa, H Irie, H Aibe, T Tajima, M Hashizume, K Masuda

    CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY   22 ( 4 )   328 - 330   1999.7

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    A 51-year-old man suffered from bleeding esophageal varices. He had undergone partial gastrectomy for gastric cancer 1 year before. An extrahepatic arterioportal fistula and resultant portal hypertension were found. We successfully performed transarterial embolization of the fistula using stainless steel coils. Portal hypertension improved dramatically.

    DOI: 10.1007/PL00012247

  • Uterine lipoleiomyoma: MRI appearances Reviewed

    K Ishigami, K Yoshimitsu, H Honda, K Kaneko, T Kuroiwa, H Irie, T Tajima, K Makizumi, T Kamura, T Shigematsu, K Masuda

    ABDOMINAL IMAGING   23 ( 2 )   214 - 216   1998.3

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    A case of uterine lipoleiomyoma demonstrated on computed tomography (CT) and magnetic resonance imaging (MRI) is described and usefulness of MRI is discussed in diagnosing this entity.

    DOI: 10.1007/s002619900326

  • Primary non-Hodgkin's lymphoma of the lacrimal sac - A case report and review of the literature Reviewed

    K Nakamura, S Uehara, J Omagari, N Kunitake, M Kimura, Y Makino, K Ishigami, K Masuda

    CANCER   80 ( 11 )   2151 - 2155   1997.12

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    BACKGROUND. Primary non-Hodgkin's lymphoma of the lacrimal sac is extremely rare, with most reported cases representing secondary involvement of a systemic malignancy.
    METHODS. The clinical record of a 70-year-old female who presented with epiphora and swelling of the lacrimal sac area is described. A review of the literature of patients with primary lacrimal sac lymphoma also is presented.
    RESULTS. Computed tomography demonstrated a lacrimal sac mass involving the nasolacrimal canal. Histopathologic examination of a biopsy specimen revealed a diffuse large cell lymphoma. Using immunohistologic staining, the tumor was a B-cell type, similar to those described in the literature. The patient was treated with 50 gray of irradiation and chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone. The patient remained free of lymphoma 26 months after initial treatment. An ocular examination was unremarkable except for epiphera.
    CONCLUSIONS. Radiotherapy and/or chemotherapy can treat localized lymphoma of the lacrimal sac successfully. (C) 1997 American Cancer Society.

    DOI: 10.1002/(SICI)1097-0142(19971201)80:11<2151::AID-CNCR15>3.0.CO;2-Y

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Books

  • 即戦力が身につく肝胆膵の画像診断

    編集 吉満研吾 石神康生(Role:Edit)

    メディカルサイエンスインターナショナル  2023.4 

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    Language:Japanese   Book type:Scholarly book

  • 画像診断ガイドライン 2016年版 第2版

    石神 康生(Role:Joint author)

    金原出版  2016.9 

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    Language:Japanese   Book type:Scholarly book

  • Chapter 5. CT and MRI/MRCP In Ed by Masao Tanaka Intraductal Papillary Mucinous Neoplasm of the Pancreas

    Kousei Ishigami(Role:Sole author)

    Springer  2014.1 

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    Responsible for pages:Chapter 5. CT and MRI/MRCP, pp 45-66.   Language:English   Book type:Scholarly book

  • CT of the Abdomen (1) Axial  (2) Sagittal (3) Coronal In Ed by Georges Y. El-Khoury, William J. Montgomery, Ronald A. Bergman Sectional anatomy by MRI and CT

    Kousei Ishigami(Role:Joint author)

    Churchill Livingstone  2007.7 

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    Responsible for pages:Chapter 20, pp485-504.   Language:English   Book type:Scholarly book

  • CT of the Female Pelvis (1) Axial (2) Sagittal (3) Coronal In Ed by Georges Y. El-Khoury, William J. Montgomery, Ronald A. Bergman Sectional anatomy by MRI and CT

    Kousei Ishigami(Role:Joint author)

    Churchill Livingstone  2007.7 

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    Responsible for pages:Capter 23, pp549-564.   Language:English   Book type:Scholarly book

  • CT of the Male Pelvis (1) Axial (2) Sagittal (3) Coronal In Ed by Georges Y. El-Khoury, William J. Montgomery, Ronald A. Bergman Sectional anatomy by MRI and CT

    Kousei Ishigami(Role:Joint author)

    Churchill Livingstone  2007.7 

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    Responsible for pages:Capter 22, pp543-548.   Language:English   Book type:Scholarly book

  • この所見をみたらどう考える?肝胆膵鑑別診断のKey point

    石神 康生, 小林 聡

    Gakken  2025    ISBN:9784055201131

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    Language:Japanese  

    CiNii Books

  • 即戦力が身につく肝胆膵の画像診断 = Practical case review hepatobiliary and pancreatic imaging

    吉満 研吾, 石神 康生

    メディカル・サイエンス・インターナショナル  2023    ISBN:9784815730703

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    Language:Japanese  

    CiNii Books

  • 肝胆膵のCT・MRI

    石神 康生(Role:Joint author)

    メディカル・サイエンス・インターナショナル  2016.4 

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    Responsible for pages:胆管内乳頭状腫瘍 pp134-135 肝粘液性嚢胞腫瘍 pp136-137   Language:Japanese   Book type:Scholarly book

  • 肝胆膵の鑑別診断のポイント

    石神 康生(Role:Joint author)

    学研メディカル秀潤社  2016.3 

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    Responsible for pages:胆道系の拡張の鑑別 pp s136-s141 肝門部腫瘍の鑑別  pp s146-s151   Language:Japanese   Book type:Scholarly book

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Presentations

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MISC

  • Necrotizing Fasciitis Caused by Xanthogranulomatous and Emphysematous Pyelonephritis : Importance of the Inferior Lumbar Triangle Pathway.

    Ishigami K, Bolton-Smith JA, DeYoung BR, Barloon TJ.

    AJR Am J Roentgenol. 2004 Dec; 183(6): 1708-1710.   2004.12

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  • Adrenal Adenoma with Organizing Hematoma: Diagnostic Dilemma at MR Imaging.

    Ishigami K, Stolpen AH, Sato Y, Dahmoush L, Winfield HN, Fajardo LL.

    Magn Reson Imaging. 2004 Oct; 22(8) 1157-1159.   2004.10

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  • Imaging of an Accessory Spleen Presenting as a Slow-Growing Mass in the Transplanted Pancreas

    Ishigami K, Hammett BK, Obuchi M, Katz DA, Rayhill SC, Fathala AL, Abu-Yousef MM.

    AJR Am. J. Roentgenol. 2004 Aug;183(2):405 - 407.   2004.8

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  • Diffuse Infiltrating Neuroendocrine Tumor of the Uterus: MRI appearance.

    Ishigami K, Peterson JJ, Stolpen AH, Dahmoush L, Fajardo LL.

    J of Women’s Imaging. 2004 Jun;6(2):85-88.   2004.6

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  • Portal Vein Occlusion with Aberrant Left Gastric Vein Functioning as a Hepatopetal Collateral Pathway.

    Ishigami K, Sun S, Berst MJ, Heery SD, Fajardo LL.

    J Vasc Interv Radiol. 2004 May;15(5):501-504.   2004.5

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  • Intravascular Gas in the Transplanted Kidney: A Sign of Extensive Graft Necrosis.

    Ishigami K, Olsen KM, Hammett BK, Katz DA, Wu YM.

    Emerg Radiol. 2004 Apr; 10(5):279-281.   2004.4

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  • Gas-forming abdominal wall abscess: unusual manifestation of perforated retroperitoneal appendicitis extending through the superior lumbar triangle.

    Ishigami K, Khanna G, Samuel I, Dahmoush L, Sato Y.

    Emerg Radiol. 2004 Feb;10(4):207-209.   2004.2

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  • Ruptured Splenic Abscess: A Cause of Pneumoperitoneum in a Patient with AIDS.

    Ishigami K, Decker GT, Bolton-Smith JA, Samuel I, Wilson SR, Brown BP.

    Emerg Radiol. 2003 Dec;10(3):163-165.   2003.12

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  • Coil embolization of arterioportal fistula that developed after partial gastrectomy.

    Ishigami K, Yoshimitsu K, Honda H, Kuroiwa T, Irie H, Aibe H, Tajima T, Hashizume M, Masuda K.

    Cardiovasc Intervent Radiol. 1999 Jul-Aug;22(4):328-330.   1999.7

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  • Uterne lipoleiomyoma: MRI appearances.

    Ishigami K, Yoshimitsu K, Honda H, Kaneko K, Kuroiwa T, Irie H, Tajima T, Makizumi K, Kamura T, Shigematsu T, Masuda K.

    Abdom Imaging. 1998 Mar-Apr;23(2):214-216.   1998.3

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  • 【絶対苦手分野にしない 消化管の画像診断】消化管間質腫瘍(GIST)のすべて

    鶴丸 大介, 井上 明星, 西牟田 雄祐, 南條 勝哉, 石神 康生

    臨床画像   40 ( 11 )   1302 - 1310   2024.11   ISSN:0911-1069

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    Language:Japanese   Publisher:(株)メジカルビュー社  

    <文献概要>胃の粘膜下腫瘍は,2cm未満は経過観察,5cm以上は治療が考慮されるため,2~5cmの病変において消化管間質腫瘍(GIST)を想定した画像診断が重要となる。GISTは,ほかの間葉系腫瘍(平滑筋腫,神経鞘腫)と比べて増強パターンや局在が鑑別点となるが,オーバーラップする場合は診断に苦慮することがある。

  • 【進行胃癌の診断と治療方針2024】進行胃癌の進行度診断体系update

    鶴丸 大介, 西牟田 雄祐, 南條 勝哉, 石神 康生

    胃と腸   59 ( 11 )   1663 - 1672   2024.11   ISSN:0536-2180

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    <文献概要>●胃癌の進行度診断は,壁深達度(T),リンパ節転移(N),その他の転移(M)を基準とする.「胃癌取扱い規約 第15版」では,胃癌の進行度は臨床分類と病理学的分類に分けられ,原発巣の進行度はT2とT3およびT4aとT4b,リンパ節転移はN0とN1~3を鑑別する.いずれの診断も造影CTによる画像診断が基本となる.特に胃を拡張した状態で撮像する3次元CT(CT gastrography)は診断精度が高く有用である.また増強パターンにより病理組織学的診断を類推することができる.MRIは,肝転移の補助的診断として有用である.FDG-PETは,胃癌の進行度診断における貢献度は低い.

  • 【絶対苦手分野にしない 消化管の画像診断】胃癌のCTどこまで読める?

    西牟田 雄祐, 鶴丸 大介, 石神 康生

    臨床画像   40 ( 11 )   1286 - 1293   2024.11   ISSN:0911-1069

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    <文献概要>胃癌はわが国において頻度が高く,悪性腫瘍による死亡者数の上位を占めている。根治的な治療のためには病変の完全切除が必要であり,治療法の選択や予後予測のために,正確な病期診断を行うことは重要である。造影CTは胃癌の病期診断に必須の検査であり,組織型や浸潤形式など性状評価,治療効果の予測など画像バイオマーカーとしての役割にも期待が寄せられている。

  • 【必見! 画像診断医のための各種ガイドラインの読み解き方】消化管領域 消化管癌のアップデートおよび日常臨床で注意すべき消化管疾患

    下村 悠太朗, 鶴丸 大介, 篠崎 賢治, 宮坂 光俊, 村木 俊夫, 石神 康生

    臨床画像   40 ( 10月増刊 )   88 - 98   2024.10   ISSN:0911-1069

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    <文献概要>消化管領域においてCTやMRIなどによる画像診断は消化管癌の病期診断やさまざまな消化管疾患の評価に有用である。本稿では消化管癌の画像診断における注意点に加えて,消化管領域のトピックスとしてirAE大腸炎,2021年より保険適用となったペプチド受容体核医学内用療法(PRRT)について概説する。

  • 【肝胆膵のcommon diseaseにみる非典型的画像所見】膵漿液性嚢胞腫瘍(SCN)

    牧瀬 智, 藤田 展宏, 中山 智博, 牛島 泰宏, 岡本 大佑, 石松 慶祐, 田畑 公佑, 石神 康生

    画像診断   44 ( 12 )   1202 - 1208   2024.9   ISSN:0285-0524

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    <文献概要>Point●膵漿液性嚢胞腫瘍(SCN)は基本的には良性腫瘍であり,他の悪性ポテンシャルをもつ膵腫瘍性病変との鑑別が重要である.●SCNの中で頻度が高いのは,microcystic typeとmixed typeである.microcystic typeはSCNの典型像とされ,血流豊富な隔壁を伴う蜂巣状構造(honeycombed appearance)を呈する嚢胞性病変である.●SCNの非典型例として,macrocystic(oligocystic)type,solid typeがある.●macrocystを伴うSCNでは膵粘液性嚢胞腫瘍(MCN)や膵管内乳頭粘液性腫瘍(IPMN)との鑑別,microcystic typeやsolid typeのSCNでは膵神経内分泌腫瘍(PNEN)との鑑別が重要である.

  • 【これからの胃癌診療】胃癌の放射線診断

    西牟田 雄祐, 鶴丸 大介, 甲斐 聖広, 南條 勝哉, 石神 康生

    臨床消化器内科   39 ( 8 )   872 - 881   2024.7   ISSN:0911-601X

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    <文献概要>胃癌は本邦で頻度が高く,死亡原因の上位に位置する消化管悪性腫瘍である.治療には病変の完全切除が必要であり,治療前の正確な病期診断が重要である.CTは胃癌の病期診断に必須の検査であり,腫瘍の深達度,リンパ節転移や遠隔転移を評価が可能である.発泡剤や飲水による胃壁の伸展および造影剤の使用により,胃壁の詳細な構造が明確に描出され,腫瘍の広がりをより正確に評価可能である.マルチスライスCTや多断面再構成(MPR)技術により,腫瘍の検出率と診断精度が向上している.また,PET/CTの併用により,遠隔転移や再発の検出精度も高まる.

  • 【日常診療での超音波検査のおさえどころ】超音波検査の歴史と進歩

    石神 康生

    臨牀と研究   101 ( 7 )   779 - 780   2024.7   ISSN:0021-4965

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  • 【日常診療での超音波検査のおさえどころ】日常診療での超音波検査 腎臓

    木村 知子, 牛島 泰宏, 小宮 勲, 加藤 豊幸, 石神 康生

    臨牀と研究   101 ( 7 )   817 - 823   2024.7   ISSN:0021-4965

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  • 【悪性リンパ腫の画像診断:間違えやすい疾患との鑑別のポイント】消化管

    南條 勝哉, 西牟田 雄祐, 鶴丸 大介, 鳥巣 剛弘, 石神 康生

    臨床放射線   69 ( 4 )   473 - 482   2024.7   ISSN:0009-9252

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    <文献概要>消化管悪性リンパ腫は消化管悪性腫瘍の約1~2%と頻度は低いものの,悪性リンパ腫でみれば消化管はすべての節外リンパ腫の約40%を占めており,実臨床では比較的遭遇することも多い。臓器別では胃が最も多く(50~60%),次いで小腸(20~30%),大腸(5~15%)の順で,食道のものはまれ(<1%)である。これは食道が他の消化管と比較して,リンパ網内系組織が少ないためとされる。

  • 【動脈・静脈の疾患2024(上)-最新の診断・治療動向-】動脈・静脈疾患の検査 静脈疾患の検査 MR venographyの概要と進歩

    鷺山 幸二, 神谷 武志, 山崎 誘三, 日野 卓也, 石神 康生

    日本臨床   82 ( 増刊4 動脈・静脈の疾患2024(上) )   177 - 182   2024.6   ISSN:0047-1852

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  • 【まれに出会うと悩ましい 肝病変の画像診断】肝腫瘍治療後にまれにみられる肝病変や肝実質の変化

    友利 由佳理, 西江 昭弘, 石神 康生

    臨床画像   40 ( 5 )   600 - 611   2024.5   ISSN:0911-1069

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    <文献概要>肝細胞癌(HCC)は治療選択肢の多い疾患で,背景の肝予備能や腫瘍径,進行期などによって変化する。放射線科医は治療後の画像を目にする機会も多く,正しく診断するためには治療ごとの肝腫瘍や肝実質の変化について精通しておく必要がある。本稿ではHCCを中心に,まれながら出会う可能性がある画像所見について概説する。

  • Cortical high-flow signの有用性:Oligodendroglioma検出能におけるASL法とDSC法の比較

    山下孝二, 栂尾理, 菊地一史, 空閑太亮, 吉本幸司, 石神康生

    日本神経放射線学会プログラム・抄録集   53rd   2024

  • Overview of MR venography and recent advances

    鷺山幸二, 神谷武志, 山崎誘三, 日野卓也, 石神康生

    日本臨床   82   2024   ISSN:0047-1852

  • 【非典型症例と類似疾患を知ってCommon Diseaseを極める】腹部 消化器 消化管

    鶴丸 大介, 西牟田 雄祐, 南條 勝哉, 石神 康生

    臨床放射線   68 ( 12 )   1273 - 1277   2023.12   ISSN:0009-9252

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    <文献概要>消化管領域において,癌は遭遇しやすい疾患の1つである。多くは内視鏡で確定診断がなされるが,病期診断も含めて造影CTが施行されるため,放射線科医にとってなじみのある疾患と思われる。消化管癌は共通してCTで典型的な画像所見である壁肥厚を示すため,診断に苦慮することは少ない。一方で,まれながら他の悪性腫瘍や良性疾患と紛らわしいことも経験する。本稿では,消化管癌の典型的な画像診断について,消化管では最もなじみのある造影CT所見を中心に解説する。

  • 【全身の血栓症・塞栓症を考える】肺動脈血栓症・塞栓症

    山崎 誘三, 神谷 武志, 鷺山 幸二, 日野 卓也, 田畑 公佑, 木佐貫 恵, 藪内 英剛, 石神 康生

    画像診断   43 ( 14 )   1379 - 1389   2023.11   ISSN:0285-0524

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    <文献概要>Point ●急性肺血栓塞栓症と慢性肺血栓塞栓症では,血管内の血栓の分布や形態が異なり,画像的に鑑別が可能である.●慢性血栓塞栓性肺高血圧症や肺腫瘍血栓性微小血管症では,CT肺動脈造影で粗大な血栓がみられないことは疾患を否定する根拠にならない.●腫瘍塞栓症は時に血栓塞栓症と鑑別困難な所見を呈し,18F-FDG-PET/CTが鑑別に有用である.

  • 【癌治療後の局所再発と転移の画像診断】胃

    鶴丸 大介, 西牟田 雄祐, 甲斐 聖広, 石神 康生

    画像診断   43 ( 11 )   A76 - A84   2023.9   ISSN:0285-0524

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    <文献概要>Point ●胃癌の再発は腹膜播種再発が多く,造影CTで診断する.●腹膜播種再発は,腹膜・腹腔内の結節,軟部腫瘤,腹水を認める.●局所再発は,消化管や胆管の閉塞による機能障害が画像として現れる.

  • 肺癌の画像診断—特集 肺癌治療の新時代 ; 診断

    日野 卓也, 神谷 武志, 鷺山 幸二, 山崎 誘三, 田畑 公佑, 石神 康生

    臨牀と研究 = The Japanese journal of clinical and experimental medicine   2023.8

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  • 肺癌の画像診断—特集 肺癌治療の新時代 ; 診断

    日野 卓也, 神谷 武志, 鷺山 幸二, 山崎 誘三, 田畑 公佑, 石神 康生

    臨牀と研究 = The Japanese journal of clinical and experimental medicine   100 ( 8 )   922 - 927   2023.8   ISSN:0021-4965

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  • 【肺癌治療の新時代】診断 肺癌の画像診断

    日野 卓也, 神谷 武志, 鷺山 幸二, 山崎 誘三, 田畑 公佑, 石神 康生

    臨牀と研究   100 ( 8 )   922 - 927   2023.8   ISSN:0021-4965

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  • 【令和にアップデートしたい 膵癌の画像診断】撮像法

    石松 慶祐, 藤田 展宏, 石神 康生

    臨床画像   39 ( 7 )   730 - 737   2023.7   ISSN:0911-1069

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    <文献概要>膵癌の診断におけるCT,MRIの撮像法について述べる。dynamic造影CTは腫瘍の検出,局所浸潤,転移,播種,血管解剖などの評価に重要である。MRIは原発巣の評価に加え,MRCPを用いた胆管および膵管の評価やEOB造影による肝転移の検出においても有用性が高い。

  • 【絶対苦手分野にしない 成人先天性心疾患の画像診断】Fallot四徴症

    山崎 誘三, 神谷 武志, 石神 康生

    臨床画像   39 ( 6 )   614 - 621   2023.6   ISSN:0911-1069

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    <文献概要>Fallot四徴症は,頻度の高い複雑先天性心疾患であり,日常診療で出くわす機会も多い。ほとんどが小児期に修復術を受けているが,成人期になって再手術が必要となることが多い。MRIは肺動脈弁逆流率の計測,正確な右心室容積計測が可能であり,再手術の適応評価に重要である。CTも形態評価やカテーテル治療の適応評価のために頻用されている。

  • 【食道・胃・大腸癌の最新情報】最新の画像診断

    甲斐 聖広, 鶴丸 大介, 西牟田 雄祐, 石神 康生

    臨牀と研究   100 ( 6 )   668 - 672   2023.6   ISSN:0021-4965

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  • 【-最新の診断・治療と病態-】診断 CT,MRI

    鶴丸 大介, 西牟田 雄祐, 甲斐 聖広, 石神 康生

    日本臨床   81 ( 増刊5 最新臨床大腸癌学2023 )   107 - 110   2023.5   ISSN:0047-1852

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  • 【胸部X線診断再入門-症例から学ぶ読影法-】異常影は肺内?それとも肺外?(part 2) 胸膜・胸壁疾患

    樋田 知之, 神谷 武志, 藪内 英剛, 石神 康生

    画像診断   43 ( 4 )   S147 - S152   2023.3   ISSN:0285-0524

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    <文献概要>Point ▼胸膜外徴候(extrapleural sign),不完全辺縁徴候(incomplete border sign)は,肺外病変を疑う重要な所見である.▼胸水貯留は多彩な形態,陰影を呈し,時に肺内病変に類似する.▼胸部単純X線写真での胸膜・胸壁疾患の鑑別は難しいが,その陰影を適切に解釈し,さらなる画像検査や治療へとつなげることが肝要である.

  • Tetralogy of Fallot

    山崎誘三, 神谷武志, 石神康生

    臨床画像   39 ( 6 )   2023   ISSN:0911-1069

  • Pulmonary Embolism

    山崎誘三, 神谷武志, 鷺山幸二, 日野卓也, 田畑公佑, 木佐貫恵, 藪内英剛, 石神康生

    画像診断   43 ( 14 )   2023   ISSN:0285-0524

  • 増強効果の乏しいIDH-wildtype diffuse astrocytic gliomaにおけるTERT遺伝子変異の予測

    山下孝二, 栂尾理, 菊地一史, 石神康生, 空閑太亮, 吉本幸司

    日本神経放射線学会プログラム・抄録集   52nd   2023

  • 新しい診断・薬の情報 NASH/NAFLDの画像診断

    村山 僚, 藤田 展宏, 石神 康生

    肝臓クリニカルアップデート   8 ( 2 )   216 - 220   2022.12   ISSN:2189-4469

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  • 【専攻医1年目で知っておきたいCT 14のこと~指導医からのメッセージ~】指導医が伝えるCT読影のコツ 消化管出血

    鶴丸 大介, 西牟田 雄祐, 甲斐 聖広, 石神 康生

    臨床画像   38 ( 10月増刊 )   144 - 150   2022.10   ISSN:0911-1069

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    <文献概要>消化管出血は一般に内視鏡により診断,治療を行うが,造影CTが重要となるケースもある。造影CTで消化管出血を評価する場合には,動脈相での撮影が必須であり,丁寧かつ詳細な観察により造影剤の血管外漏出(extravasation)を検索する。特に大腸憩室出血では出血部の同定に造影CTの貢献度は高い。

  • 【胆嚢疾患診療の最前線】診断(隆起性病変と壁肥厚性病変の鑑別を中心に) 胆嚢病変のCT・MRI所見

    糸山 昌宏, 藤田 展宏, 石神 康生

    肝胆膵   85 ( 4 )   503 - 511   2022.10   ISSN:0389-4991

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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5章)消化器 消化管腫瘍

    西牟田 雄祐, 鶴丸 大介, 甲斐 聖広, 石神 康生

    臨床放射線   67 ( 11 )   1389 - 1397   2022.10   ISSN:0009-9252

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  • 【大腸腫瘍診療の最前線】CT colonographyの最前線

    鶴丸 大介, 西牟田 雄祐, 甲斐 聖広, 高津 憲之, 宮坂 光俊, 村木 俊夫, 上田 真信, 伊牟田 真功, 林 奈留美, 三宅 基隆, 森 一宏, 前田 和弘, 石神 康生

    胃と腸   57 ( 10 )   1281 - 1289   2022.9   ISSN:0536-2180

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    <文献概要>CTC(CT colonography)は,大腸に特化したCTの呼称であり,肛門からの送気により大腸を拡張させた状態で撮像する手法である.本邦では大腸癌の術前検査,大腸癌やポリープのスクリーニング検査として普及している.大腸癌術前検査においては,CTでのリンパ節転移診断,遠隔転移診断に加え,CTCによる局在診断および深達度診断が可能である.大腸ポリープに対するスクリーニングとしての成績は6mm以上のポリープで感度73~98%,特異度80~93%と十分に許容しうるものである.また,近年CT撮像機器の技術革新や人工知能(AI)の導入により,CTCは大腸癌診療において新たな局面を迎えている.

  • 【食道疾患の診療】食道癌の診療 食道癌に対する集学的治療 化学放射線療法

    高木 正統, 吉武 忠正, 石神 康生

    臨床消化器内科   37 ( 9 )   1154 - 1157   2022.8   ISSN:0911-601X

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  • 【肝門部領域胆管ドレナージを極める】肝門部胆管狭窄のCT・MRI

    岡本 大佑, 中山 智博, 川野 倫作, 大塚 徹, 石神 康生

    消化器内視鏡   34 ( 6 )   1053 - 1060   2022.6   ISSN:0915-3217

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    肝門部胆管狭窄をきたす疾患は、胆管癌などの悪性腫瘍、原発性硬化性胆管炎やIgG4関連硬化性胆管炎などの炎症性疾患、肝移植後の吻合部狭窄など多岐にわたる。良・悪性の鑑別、悪性腫瘍の手術適応、閉塞性黄疸に対するドレナージ経路の選択などにおけるCTおよびMRIの役割は大きい。本稿では、胆道系疾患に対するCT・MRIの撮像法や代表的疾患における画像所見について概説する。(著者抄録)

  • 消化器医にちょっと役立つ豆知識 胆膵MRIの基礎知識(第4回) EOB造影MRI

    藤田 展宏, 石神 康生

    消化器クリニカルアップデート   3 ( 2 )   232 - 237   2022.5   ISSN:2435-256X

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  • 少量造影剤による低管電圧TAVI-CTにおけるDeep Learning Reconstructionの有用性

    小島 宰, 山崎 誘三, 松浦 由布子, 白坂 崇, 加藤 豊幸, 藪内 英剛, 石神 康生

    日本放射線技術学会総会学術大会予稿集   2022.3

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  • 【局所進展とリンパ節転移に力点をおいた画像による癌の病期診断2022】胃

    鶴丸 大介, 高津 憲之, 甲斐 聖広, 石神 康生

    画像診断   42 ( 4 )   S84 - S93   2022.3   ISSN:0285-0524

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  • 【生検 最近の潮流】軟部腫瘍診療における生検と画像診断の役割

    鷺山 幸二, 神谷 武志, 山崎 誘三, 樋田 知之, 松浦 由布子, 藪内 英剛, 牛島 泰宏, 石神 康生

    日本インターベンショナルラジオロジー学会雑誌   36 ( 2 )   119 - 125   2022.3   ISSN:1340-4520

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    軟部腫瘍の発生部位は四肢をはじめ全身に及び、皮下や筋間、筋肉、後腹膜など深度も様々である。良性腫瘍、中間悪性腫瘍、希少癌の悪性軟部腫瘍に分けられる。診断は病理診断により確定されるが、不適切な生検手技は患者の予後を悪化させる。軟部腫瘍の病理診断と根治的治療の手術に関して簡単に述べ、現在大きな問題になっている無計画切除に言及した。各生検技法の概要と注意点を述べ、その補助となる画像モダリティーの特徴を解説した。画像ガイド下針生検が奏効した症例を紹介した。

  • 腹部臓器の画像診断の現状と課題

    石神 康生, 杉町 圭蔵

    臨牀と研究   99 ( 2 )   252 - 258   2022.2   ISSN:0021-4965

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  • 【癌治療後の画像変化と合併症】肝細胞癌の治療後画像変化と合併症

    前原 純樹, 亀井 僚太郎, 山下 孝二, 野口 智幸, 石神 康生

    臨床放射線   67 ( 2 )   139 - 150   2022.2   ISSN:0009-9252

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    <文献概要>肝細胞癌(hepatocellular carcinoma:HCC)は,放射線科医にとって因縁深い相手である。慢性肝障害の患者は頻回の画像検査を要し,新規病変を丹念に検索する必要がある。また,肝動脈化学塞栓療法(transcatheter arterial chemoembolization:TACE)により,放射線診断医が自ら癌の治療を行う疾患の一つである。HCCは,新規病変を発見することと同等以上に,治療を行った病変の画像所見や合併症の評価が重要である。2020年に免疫チェックポイント阻害薬と分子標的薬の併用療法が適応となり,HCCの治療は新たな局面を迎えている。薬物療法による治療成績が向上したことで,焼灼療法やTACE後の再発を経て薬物治療を行う例など,多様な治療内容を理解したうえで画像を評価する必要がある。本稿では,HCCに対する主な治療法について簡単に触れ,それぞれの治療後変化や合併症について解説する。

  • 新しい画像診断技術のデジタルX線動画撮影(DDR)はファロー四徴症術後の肺動脈狭窄のスクリーニング検査として有用である。

    豊村大亮, 永田弾, 山崎誘三, 長友雄作, 平田悠一郎, 福岡将治, 山村健一郎, 石神康生, 大賀正一

    日本小児循環器学会総会・学術集会(Web)   58th   2022

  • Withコロナ時代の肺炎の画像診断—特集 Withコロナ時代の肺炎診療 ; 肺炎の診断

    藪内 英剛, 神谷 武志, 鷺山 幸二, 山崎 誘三, 樋田 知之, 松浦 由布子, 石神 康生

    臨牀と研究 = The Japanese journal of clinical and experimental medicine   2021.11

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  • CT radiomics analysis of lung cancers: Differentiation of squamous cell carcinoma from adenocarcinoma, a correlative study with FDG uptake. Reviewed

    Yukari Tomori, Tsuneo Yamashiro, Hayato Tomita, Maho Tsubakimoto, Kousei Ishigami, Eriko Atsumi, Sadayuki Murayama

    European journal of radiology   2020.7

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    BACKGROUND AND PURPOSE: Pulmonary squamous cell carcinoma (SCC) was reported to have significantly higher histogram_kurtosis obtained by unenhanced computed tomography (CT) and a greater maximum standardized uptake value (SUVmax) determined by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) than pulmonary adenocarcinoma (AD). The first study aim was to investigate whether CT radiomics features could differentiate SCC from AD. The second aim was to investigate correlations between CT radiomics features and SUVmax. MATERIALS AND METHODS: Forty solid lung tumors < 3 cm in diameter pathologically proven to be SCC (n = 18) or AD (n = 22) were included. The SUVmax was determined by 18F-FDG-PET/CT and 42 CT radiomics features were obtained from unenhanced CT. A Mann-Whitney U test was used to compare the SUVmax and each CT radiomics feature to differentiate SCC from AD. The area under the curve (AUC) was calculated from receiver operating characteristic (ROC) analysis. A binary logistic regression analysis was performed for a combination of SUVmax with each CT radiomics feature. A Spearman rank correlation analysis was performed to determine correlations between SUVmax and CT radiomics features. RESULTS: Twenty-six of 42 CT radiomics features were significantly different between groups. The best AUC of the CT radiomics features was 0.81 for both the GLRLM_SRHGE and GLZLM_HGZE. The AUC value improved when the shape_sphericity feature was combined with SUVmax (AUC = 0.92). The CT radiomics features exhibiting strongest correlations with the SUVmax were different in both AD and SCC groups. CONCLUSION: CT radiomics features correlated with tumor structural characteristics of SCC and AD, and were closely related to metabolic information from FDG-PET/CT.

    DOI: 10.1016/j.ejrad.2020.109032

  • 膵mucinous nonneoplastic cystの画像所見

    石神 康生, 西江 昭弘, 浅山 良樹, 牛島 泰宏, 柿原 大輔, 藤田 展宏, 森田 孝一郎, 石松 慶祐, 高尾 誠一郎, 本田 浩

    Japanese Journal of Radiology   2020.2

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  • Gd-DTPA-EOB造影MRI動脈相におけるアーチファクトの低減 加温の有無による比較

    石松 慶祐, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 柿原 大輔, 藤田 展宏, 森田 孝一郎, 高尾 誠一郎, 本田 浩

    Japanese Journal of Radiology   2020.2

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  • 【遭遇の機会が増えたIPMN/膵嚢胞-現状と課題】IPMN/膵嚢胞の診療 IPMN/膵嚢胞のCT,MRI診断

    石神 康生, 中俣 彰裕, 宜保 慎司, 宮良 哲博, 村山 貞之

    臨床消化器内科   2019.10

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    <文献概要>膵管内乳頭粘液性腫瘍(IPMN)のCT,MRI/MRCP所見を提示し,IPMNの良悪性診断,経過観察における注意点について解説した.CT,MRIで分枝型IPMNとの鑑別がもっとも問題となるのは漿液性嚢胞腫瘍(serouscystic neoplasm;SCN)である.分枝型IPMNとSCNとが鑑別困難となる原因はある程度決まっているので,CTやMRI診断でのピットフォールを理解することは重要である.その他の腫瘍性膵嚢胞,非腫瘍性膵嚢胞の画像所見についても解説した.

  • 腹腔動脈起始部狭窄に伴う膵十二指腸動脈瘤の血管内治療時にSMA血栓症を生じた1例

    佐久川 貴行, 中俣 彰裕, 宜保 慎司, 渡口 真史, 伊良波 裕子, 平安名 常一, 石神 康生, 村山 貞之

    日本インターベンショナルラジオロジー学会雑誌   2019.5

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  • 腎動静脈瘻破裂と腰動脈破裂を短期間のうちに認めた神経線維腫症1型の一例

    伊藤 純二, 座波 麻耶子, 渡口 真史, 佐久川 貴行, 伊良波 裕子, 平安名 常一, 石神 康生, 比嘉 章太郎, 永野 貴昭, 村山 貞之

    日本インターベンショナルラジオロジー学会雑誌   2019.5

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  • 豊富な粘液基質が画像に反映された胃plexiform fibromyxomaの1例

    高尾 誠一朗, 森田 孝一郎, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 柿原 大輔, 藤田 展宏, 石松 慶祐, 本田 浩, 大内田 研宙, 江崎 幹宏, 山元 英崇, 佐伯 潔

    Japanese Journal of Radiology   2019.2

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  • CT perfusionを用いた肝右葉グラフトのうっ血領域の血行動態解析

    森田 孝一郎, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 柿原 大輔, 藤田 展宏, 石松 慶祐, 高尾 誠一朗, 本田 浩

    Japanese Journal of Radiology   2019.2

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  • 大動脈ステント留置後のtypeIIエンドリークに対する,ドップラー・ソナゾイドUSの初期経験

    牛島 泰宏, 西江 昭弘, 石神 康生, 岡本 大佑, 藤田 展宏, 本田 浩, 浅山 良樹, 高山 幸久

    Japanese Journal of Radiology   2019.2

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  • 急性膵炎と低血糖が先行し、膵CT所見の経時的変化を観察しえた劇症1型糖尿病の1例

    宮ヶ原 典, 藤森 尚, 大野 隆真, 岡本 実里, 佐藤 直市, 園田 紀之, 孝橋 賢一, 石神 康生, 小川 佳宏

    日本消化器病学会雑誌   2019.2

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    30歳、男性。急性膵炎の診断で前医に入院し、第2病日に低血糖が出現したが、第4病日より高血糖となりCTで膵全体にまだらな低吸収域が出現した。第8病日に当院に転院となり、ケトアシドーシス発症を契機に劇症1型糖尿病と診断されたが、その際のCTでは低吸収域は消失していた。膵生検では膵島は認められなかった。急性膵炎と低血糖が先行し、膵CT所見の経時的変化を観察しえた非常にまれな劇症1型糖尿病の1例を経験した。(著者抄録)

  • 術前診断が困難であった乳頭状腎癌の1例

    平木 嘉樹, 岡本 大佑, 西江 昭弘, 石神 康生, 牛島 泰宏, 藤田 展宏, 本田 浩, 浅山 良樹, 高山 幸久

    Japanese Journal of Radiology   2019.2

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  • 画像診断と病理 肝内胆管癌 画像

    浅山 良樹, 西江 昭弘, 石神 康生, 牛島 泰宏, 柿原 大輔, 藤田 展宏, 森田 孝一郎, 石松 慶祐, 高尾 誠一朗, 本田 浩

    肝臓クリニカルアップデート   2018.10

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  • 嚢胞性膵腫瘍の画像診断

    石神 康生

    日本医学放射線学会秋季臨床大会抄録集   2018.9

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    嚢胞性膵腫瘍の画像診断

  • 【肝の画像診断update】肝悪性腫瘍の画像診断

    藤田 展宏, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 柿原 大輔, 中山 智博, 本田 浩

    画像診断   2018.8

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    【肝の画像診断update】 肝悪性腫瘍の画像診断
    <文献概要>近年の肝幹細胞および肝細胞・胆管細胞の分化の研究の進歩により,これらを由来とする肝悪性腫瘍の発生の理解がより深まっている.特に,細胆管癌,混合型肝癌,胆管形質を示す肝細胞癌や低分化肝細胞癌などの特殊な肝腫瘍では,これらの発生を理解し,正確な画像診断につなげることが重要である.

  • EVAR後type II endoleakに対し経皮経腹的直接穿刺による塞栓術を施行した1例

    高尾 誠一朗, 浅山 良樹, 西江 昭弘, 石神 康生, 牛島 泰宏, 柿原 大輔, 藤田 展宏, 森田 孝一郎, 石松 慶祐, 本田 浩

    IVR: Interventional Radiology   2018.8

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  • EVAR後type II endoleakに対し経皮経腹的直接穿刺による塞栓術を施行した1例

    高尾 誠一朗, 浅山 良樹, 西江 昭弘, 石神 康生, 牛島 泰宏, 柿原 大輔, 藤田 展宏, 森田 孝一郎, 石松 慶祐, 本田 浩

    IVR: Interventional Radiology   2018.8

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    EVAR後type II endoleakに対し経皮経腹的直接穿刺による塞栓術を施行した1例

  • 【所見から進める膵腫瘤の鑑別】嚢胞性腫瘤 主膵管との交通を示すもの

    石神 康生, 西江 昭弘, 浅山 良樹, 本田 浩

    臨床画像   2018.6

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    【所見から進める膵腫瘤の鑑別】 嚢胞性腫瘤 主膵管との交通を示すもの
    主膵管と交通する嚢胞性腫瘤として膵管内乳頭粘液性腫瘍(IPMN)、貯留嚢胞、仮性嚢胞の画像所見を中心に解説した。これらのなかで膵管との交通の有無が診断上で重要なのは分枝型IPMNである。貯留嚢胞では膵管との交通の有無よりも、閉塞機転の原因としての膵癌の除外が重要である。仮性嚢胞の診断は経過が明らかな場合は容易である。一方、経過が不明な慢性仮性嚢胞では膵管との交通もわかりにくく、診断に苦慮することがある。(著者抄録)

  • 【腸の画像診断update】ヘルニア

    森田 孝一郎, 浅山 良樹, 西江 昭弘, 石神 康生, 牛島 泰宏, 柿原 大輔, 藤田 展宏, 本田 浩

    画像診断   2018.4

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    【腸の画像診断update】 ヘルニア
    <文献概要>ヘルニアには,腹腔内臓器が腹腔外に脱出する外ヘルニアと,腹腔内の陥凹や異常裂孔に腹腔内臓器が陥入する内ヘルニアがある.内ヘルニアの頻度は低いが絞扼することが多く,重篤になりやすい.内ヘルニアの診断にはCTが有用で,ヘルニア門に収束する腸間膜の脈管と,ランドマークとなる血管が診断の鍵になる.

    DOI: 10.15105/GZ.0000000495

  • 【マルチモダリティによるAbdominal Imaging 2018【臨床編】Radiomics時代を支える最新診断技術】MRIのベネフィット&ポテンシャル 肝におけるMRIを用いたradiomics

    石松 慶祐, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 柿原 大輔, 藤田 展宏, 森田 孝一郎, 高尾 誠一朗, 本田 浩

    INNERVISION   2018.4

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    【マルチモダリティによるAbdominal Imaging 2018【臨床編】Radiomics時代を支える最新診断技術】 MRIのベネフィット&ポテンシャル 肝におけるMRIを用いたradiomics

  • 術前診断が困難であったmitotically active cellular fibromaの1例

    眞鍋 裕介, 高山 幸久, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 藤田 展宏, 本田 浩

    Japanese Journal of Radiology   2018.2

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    術前診断が困難であったmitotically active cellular fibromaの1例

  • 当院における腎腫瘍に対する経皮的凍結療法の短期治療成績と安全性の検討

    岡本 大佑, 浅山 良樹, 西江 昭弘, 石神 康生, 牛島 泰宏, 藤田 展宏, 本田 浩, 高山 幸久

    Japanese Journal of Radiology   2018.2

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    当院における腎腫瘍に対する経皮的凍結療法の短期治療成績と安全性の検討

  • 後腹膜腔に生じた腸管重複嚢胞の1例

    桃坂 大地, 牛島 泰宏, 西江 昭弘, 浅山 良樹, 石神 康生, 岡本 大佑, 藤田 展宏, 本田 浩, 高山 幸久, 池田 哲夫

    Japanese Journal of Radiology   2018.2

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    後腹膜腔に生じた腸管重複嚢胞の1例

  • 膵頭部を貫通する総肝動脈の頻度と合併する画像解剖所見

    石神 康生, 西江 昭弘, 浅山 良樹, 牛島 泰宏, 高山 幸久, 岡本 大佑, 藤田 展宏, 本田 浩

    Japanese Journal of Radiology   2018.2

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    膵頭部を貫通する総肝動脈の頻度と合併する画像解剖所見

  • 胆嚢悪性腫瘍の画像診断

    石神 康生

    日本医学放射線学会秋季臨床大会抄録集   2017.8

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    胆嚢悪性腫瘍の画像診断

  • 腎門部腫瘍に対する凍結療法の治療成績

    岡本 大佑, 浅山 良樹, 西江 昭弘, 石神 康生, 牛島 泰宏, 高山 幸久, 藤田 展宏, 本田 浩

    IVR: Interventional Radiology   2017.4

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    腎門部腫瘍に対する凍結療法の治療成績

  • 膵疾患の画像診断Update ─診療ガイドラインを踏まえて─ IPMN,MCN,SCN

    石神 康生

    画像診断   2017.4

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  • 【膵疾患の画像診断Update-診療ガイドラインを踏まえて-】IPMN、MCN、SCN

    石神 康生, 西江 昭弘, 浅山 良樹, 牛島 泰宏, 高山 幸久, 岡本 大佑, 藤田 展宏, 本田 浩

    画像診断   2017.3

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    【膵疾患の画像診断Update-診療ガイドラインを踏まえて-】 IPMN、MCN、SCN

    DOI: 10.15105/J00235.2017187886

  • 肝血管腫におけるGd-EOB-DTPA-enhanced MRI肝細胞相の意義に関する検討

    田原 圭一郎, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 高山 幸久, 岡本 大佑, 藤田 展宏, 本田 浩

    Japanese Journal of Radiology   2017.2

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    肝血管腫におけるGd-EOB-DTPA-enhanced MRI肝細胞相の意義に関する検討

  • TEVAR後のエンドリークに対する経皮的直接穿刺による塞栓術の検討

    牛島 泰宏, 浅山 良樹, 岡本 大佑, 森田 孝一郎, 西江 昭弘, 石神 康生, 藤田 展宏, 本田 浩, 高山 幸久, 松本 拓也

    Japanese Journal of Radiology   2017.2

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    TEVAR後のエンドリークに対する経皮的直接穿刺による塞栓術の検討

  • 後腹膜脱分化型脂肪肉腫と類似する画像所見を呈した子宮内膜症の1例

    久良木 悠介, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 岡本 大佑, 藤田 展宏, 本田 浩, 高山 幸久, 植木 隆

    Japanese Journal of Radiology   2017.2

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    後腹膜脱分化型脂肪肉腫と類似する画像所見を呈した子宮内膜症の1例

  • 神経内分泌腫瘍の診断におけるソマトスタチン受容体シンチの初期経験

    染原 涼, 馬場 眞吾, 丸岡 保宏, 北村 宜之, 田原 圭一郎, 西江 昭弘, 浅山 良樹, 石神 康生, 本田 浩

    核医学   2017.2

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    神経内分泌腫瘍の診断におけるソマトスタチン受容体シンチの初期経験

  • 稀な進展形式を呈した肛門管癌術後再発の1例

    森田 孝一郎, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 岡本 大佑, 藤田 展宏, 本田 浩, 高山 幸久, 有山 寛

    Japanese Journal of Radiology   2017.2

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    稀な進展形式を呈した肛門管癌術後再発の1例

  • 【IPMNの診断と治療はどう変わったか?】診断 US、CT、MRI診断の有用性と限界は?

    石神 康生, 西江 昭弘, 浅山 良樹, 牛島 泰宏, 高山 幸久, 岡本 大佑, 藤田 展宏, 本田 浩

    胆と膵   2016.11

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    【IPMNの診断と治療はどう変わったか?】 診断 US、CT、MRI診断の有用性と限界は?
    US、CT、MRIの膵の画像診断における利点、欠点からIPMNの画像診断でのCT、MRIの有用性と限界を概説した。経腹USでは膵全体の観察が困難であり、スクリーニングや経過観察で限定的に使用される。CT、MRIは病変の検出、質的診断から経過観察まで広く使用されており、有用性も高い。CT、MRIの診断上の限界として、壁在結節の診断と検出困難な膵癌の症例がある。また、膵管との交通が描出できない分枝型IPMNでは漿液性嚢胞腫瘍との鑑別が困難な場合がある。さらに、主膵管内の病変の進展範囲も評価困難な場合がある。(著者抄録)

  • IPMN の診断と治療はどう変わったか? 診断:US,CT,MRI 診断の有用性と限界は?

    石神 康生

    胆と膵   2016.11

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  • 難治性胆汁瘻に対して選択的PTPEが有用だった1例

    前原 純樹, 岡本 大佑, 浅山 良樹, 西江 昭弘, 石神 康生, 牛島 泰宏, 高山 幸久, 藤田 展宏, 大塚 隆生, 本田 浩

    IVR: Interventional Radiology   2016.8

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    難治性胆汁瘻に対して選択的PTPEが有用だった1例

  • 【画像でみかける偶発的所見のマネジメント-あなたならどう書く?-】肝胆膵脾 膵小石灰化

    浅山 良樹, 西江 昭弘, 石神 康生, 牛島 泰宏, 本田 浩

    画像診断   2016.7

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    【画像でみかける偶発的所見のマネジメント-あなたならどう書く?-】 肝胆膵脾 膵小石灰化

    DOI: 10.15105/J00235.2016356304

  • 【画像でみかける偶発的所見のマネジメント-あなたならどう書く?-】肝胆膵脾 胆嚢ポリープ

    浅山 良樹, 西江 昭弘, 石神 康生, 牛島 泰宏, 本田 浩

    画像診断   2016.7

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    【画像でみかける偶発的所見のマネジメント-あなたならどう書く?-】 肝胆膵脾 胆嚢ポリープ

    DOI: 10.15105/J00235.2016356302

  • 【画像でみかける偶発的所見のマネジメント-あなたならどう書く?-】肝胆膵脾 膵管内乳頭腫瘍

    浅山 良樹, 西江 昭弘, 石神 康生, 牛島 泰宏, 本田 浩

    画像診断   2016.7

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    【画像でみかける偶発的所見のマネジメント-あなたならどう書く?-】 肝胆膵脾 膵管内乳頭腫瘍

    DOI: 10.15105/J00235.2016356303

  • 腎腫瘍に対する経皮的凍結療法時のice ball径を予測する因子に関する検討

    岡本 大佑, 浅山 良樹, 西江 昭弘, 石神 康生, 牛島 泰宏, 高山 幸久, 藤田 展宏, 本田 浩

    IVR: Interventional Radiology   2016.4

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    腎腫瘍に対する経皮的凍結療法時のice ball径を予測する因子に関する検討

  • 【マルチモダリティによるAbdominal Imaging 2016[臨床編] 日常臨床における代表的疾患の画像診断のコツ】肝 肝内胆管がんと肝転移の診断

    藤田 展宏, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 高山 幸久, 岡本 大佑, 本田 浩

    INNERVISION   2016.4

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    【マルチモダリティによるAbdominal Imaging 2016[臨床編] 日常臨床における代表的疾患の画像診断のコツ】 肝 肝内胆管がんと肝転移の診断
    肝内胆管がんと肝転移は共に腺癌の頻度が最も高い。両者とも典型的には乏血性で遅延性に増強される腫瘤として描出されるが、非典型的な画像所見を呈する場合は、診断に苦慮することも多い。本稿では、肝内胆管がんと肝転移の画像所見および鑑別診断について、筆者らの検討を含めて概説する。(著者抄録)

  • 腎細胞癌に対する凍結療法における腎門部血管・腎盂への影響に対する検討(Significance of damage of renal hilar vessel and pelvis by cryoablation for renal cell carcinoma)

    牛島 泰宏, 浅山 良樹, 西江 昭弘, 石神 康生, 高山 幸久, 岡本 大佑, 藤田 展宏, 本田 浩

    IVR: Interventional Radiology   2016.4

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  • 【肝胆膵の鑑別診断のポイント】(第2章)胆道系 肝門部腫瘤の鑑別

    石神 康生, 西江 昭弘, 浅山 良樹, 本田 浩

    画像診断   2016.3

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    【肝胆膵の鑑別診断のポイント】 (第2章)胆道系 肝門部腫瘤の鑑別

  • 【肝胆膵の鑑別診断のポイント】 (第1章)肝臓 肝実質のCT吸収値びまん性上昇の鑑別

    西江 昭弘, 浅山 良樹, 石神 康生, 本田 浩

    画像診断   2016.3

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    【肝胆膵の鑑別診断のポイント】 (第1章)肝臓 肝実質のCT吸収値びまん性上昇の鑑別

  • 【肝胆膵の鑑別診断のポイント】 (第1章)肝臓 肝実質のCT吸収値びまん性低下の鑑別

    西江 昭弘, 浅山 良樹, 石神 康生, 本田 浩

    画像診断   2016.3

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    【肝胆膵の鑑別診断のポイント】 (第1章)肝臓 肝実質のCT吸収値びまん性低下の鑑別

  • 【肝胆膵の鑑別診断のポイント】 (第2章)胆道系 胆道系の拡張の鑑別

    石神 康生, 西江 昭弘, 浅山 良樹, 本田 浩

    画像診断   2016.3

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    【肝胆膵の鑑別診断のポイント】 (第2章)胆道系 胆道系の拡張の鑑別

    DOI: 10.15105/j00235.2016191743

  • 【病理像から読みとる膵・胆道画像診断のコツ】 病理像をイメージした膵・胆道画像診断の実際 病理像と画像診断との対比 腫瘤形成性膵炎の画像診断

    中島 陽平, 森 泰寿, 宮坂 義浩, 大塚 隆生, 石神 康生, 持留 直希, 小田 義直, 中村 雅史

    胆と膵   2015.12

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    【病理像から読みとる膵・胆道画像診断のコツ】 病理像をイメージした膵・胆道画像診断の実際 病理像と画像診断との対比 腫瘤形成性膵炎の画像診断
    腫瘤形成性膵炎は病態および病理組織学的な定義がいまだ明確にはされておらず、アルコール性慢性膵炎や原因不明な慢性膵炎が腫瘤を形成したもの、自己免疫性膵炎が腫瘤状を呈したものなどさまざまなものが含まれている。造影CTでは膵実質と等染を呈することが多い。Magnetic resonance imaging(MRI)、Endoscopic ultrasonography(EUS)、Endoscopic retrograde cholangiopancreatography(ERCP)でpenetrating duct signを認める場合もある。慢性膵炎や自己免疫性膵炎の典型的画像を呈していれば鑑別は比較的容易であるが、膵癌との鑑別が困難な場合も多く、画像所見や病理所見を総合的に判断することが必要である。(著者抄録)

  • 非アルコール性脂肪性肝疾患における画像診断の役割 (特集 いま話題の疾患update : 腹部編)

    西江 昭弘, 浅山 良樹, 石神 康生

    臨床放射線   2015.8

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    Role of diagnostic imaging in nonalcoholic fatty liver disease

  • 【いま話題の疾患update-腹部編-】 非アルコール性脂肪性肝疾患における画像診断の役割

    西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 高山 幸久, 岡本 大佑, 藤田 展宏, 本田 浩

    臨床放射線   2015.8

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    【いま話題の疾患update-腹部編-】 非アルコール性脂肪性肝疾患における画像診断の役割

  • 【肝胆膵イメージング:画像が映す分子病理】 肝疾患 Gd-EOB-DTPA造影MRIによる肝障害度の評価

    西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 高山 幸久, 岡本 大佑, 藤田 展宏, 森田 孝一郎, 本田 浩

    肝・胆・膵   2015.4

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    【肝胆膵イメージング:画像が映す分子病理】 肝疾患 Gd-EOB-DTPA造影MRIによる肝障害度の評価

  • 当院における腎凍結療法の初期経験

    森田 孝一郎, 浅山 良樹, 西江 昭弘, 石神 康生, 牛島 泰宏, 高山 幸久, 岡本 大佑, 藤田 展宏, 本田 浩

    IVR: Interventional Radiology   2015.2

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    当院における腎凍結療法の初期経験

  • 副腎腫瘍の鑑別における拡散強調像の有用性の検討

    樋田 知之, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 高山 幸久, 藤田 展宏, 島本 大, 本田 浩, 内藤 誠二, 久保 雄一郎

    Japanese Journal of Radiology   2015.2

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    副腎腫瘍の鑑別における拡散強調像の有用性の検討

  • 【MRCPの20年と胆膵画像診断の進歩-エキスパートに学ぶ診断技術と読影法-】 MRCPで問題となるアーチファクト

    藤田 展宏, 西江 昭弘, 中山 智博, 浅山 良樹, 石神 康生, 牛島 泰宏, 高山 幸久, 岡本 大佑, 森田 孝一郎, 渡邊 祐司, 本田 浩

    臨床画像   2014.12

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    【MRCPの20年と胆膵画像診断の進歩-エキスパートに学ぶ診断技術と読影法-】 MRCPで問題となるアーチファクト

  • 腎細胞癌に対する凍結療法 画像誘導下の新たな低侵襲治療

    牛島 泰宏, 浅山 良樹, 西江 昭弘, 岡本 大佑, 森田 孝一郎, 石神 康生, 高山 幸久, 藤田 展宏, 横溝 晃, 内藤 誠二, 本田 浩

    福岡医学雑誌   2014.10

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    腎細胞癌に対する凍結療法 画像誘導下の新たな低侵襲治療

    DOI: 10.15017/1477814

  • 診断が困難であった後腹膜脱分化型脂肪肉腫の1例

    山之内 寅彦, 西江 昭宏, 浅山 良樹, 石神 康生, 牛島 泰宏, 高山 幸久, 藤田 展宏, 本田 浩, 柿原 大輔, 猪口 淳一

    Japanese Journal of Radiology   2014.2

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    診断が困難であった後腹膜脱分化型脂肪肉腫の1例

  • Multicystic biliary hamartomaの1例

    進 政太郎, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 藤田 展宏, 本田 浩, 高山 幸久, 久保 雄一郎, 調 憲

    Japanese Journal of Radiology   2014.2

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    Multicystic biliary hamartomaの1例

  • 上腹部領域における拡散強調像の最適化と肝細胞癌の検出における有用性の検討

    高山 幸久, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 藤田 展宏, 本田 浩, 柿原 大輔, 武村 濃, 小原 真

    Japanese Journal of Radiology   2014.2

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    上腹部領域における拡散強調像の最適化と肝細胞癌の検出における有用性の検討

  • 低被曝線量を用いたCT angiographyにおける逐次近似法の効果

    藤田 展宏, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 本田 浩, 柿原 大輔, 高山 幸久, 近藤 雅敏, 調 憲

    Japanese Journal of Radiology   2014.2

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    低被曝線量を用いたCT angiographyにおける逐次近似法の効果

  • 【Gd-EOB-DTPA造影MRIをさらに深く知る】 Gd-EOB-DTPA造影MRIにおける肝細胞癌周囲の取り込み低下域と微小血管浸潤の相関

    西江 昭弘, 浅山 良樹, 石神 康生, 柿原 大輔, 中山 智博, 牛島 泰宏, 高山 幸久, 藤田 展宏, 平川 雅和, 本田 浩, 調 憲, 久保 雄一郎

    日独医報   2013.11

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    【Gd-EOB-DTPA造影MRIをさらに深く知る】 Gd-EOB-DTPA造影MRIにおける肝細胞癌周囲の取り込み低下域と微小血管浸潤の相関

  • 膵粘液性嚢胞腫瘍

    石神 康生

    画像診断33(8):912-926.   2013.8

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  • 【膵炎・膵腫瘍の画像診断-稀な疾患との鑑別も含めて-】 膵粘液性嚢胞腫瘍

    石神 康生, 西江 昭弘, 浅山 良樹, 牛島 泰宏, 高山 幸久, 藤田 展宏, 本田 浩

    画像診断   2013.6

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    【膵炎・膵腫瘍の画像診断-稀な疾患との鑑別も含めて-】 膵粘液性嚢胞腫瘍

    DOI: 10.15105/J00235.2013286005

  • 【Groove pancreatitisをめぐって】 Groove pancreatitisのCT診断

    石神 康生, Rajput Maheen, Kuehn David M, 西江 昭弘, 浅山 良樹, 本田 浩

    胆と膵   2013.4

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    【Groove pancreatitisをめぐって】 Groove pancreatitisのCT診断
    Groove pancreatitis(groove膵炎)のCT診断と鑑別診断、とくにgroove pancreatic carcinoma(groove膵癌)との鑑別上の問題点について概説した。Groove膵炎におけるCT診断の最も重要な役割は病変の存在診断であり、groove領域の異常所見を見逃さないように心掛けるべきである。Groove膵炎の病名は広く浸透しており、良性疾患としての側面が強調されてきた。Groove領域に病変を認めた場合、groove膵炎とgroove膵癌の両者の可能性を考慮する必要がある。Groove膵炎とgroove膵癌の画像診断上の鑑別点をいくつか紹介したが、両者の画像所見には重複が多く、鑑別困難例が少なくない。画像診断での鑑別に拘泥しすぎることなく、生検での確認を検討すべきである。(著者抄録)

  • Groove pancreatitisのCT診断

    石神 康生

    胆と膵 34(4):285-289.   2013.4

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  • 男性に発症した後腹膜原発の粘液性嚢胞腺腫の1例

    藤田 展宏, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 高山 幸久, 山之内 寅彦, 本田 浩, 柿原 大輔, 清島 圭二郎, 久保 雄一郎

    Japanese Journal of Radiology   2013.2

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    男性に発症した後腹膜原発の粘液性嚢胞腺腫の1例

  • Multicystic renal dysplasiaの1例

    森田 孝一郎, 西江 昭弘, 浅山 良樹, 石神 康生, 中山 智博, 高山 幸久, 本田 浩, 柿原 大輔, 内藤 誠二, 藤田 展宏

    Japanese Journal of Radiology   2013.2

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    Multicystic renal dysplasiaの1例

  • 【再びIPMNの切除適応を考える】 IPMNに併存する通常型膵癌の診断をどうするか?

    大塚 隆生, 井手野 昇, 田村 公二, 安蘇 鉄平, 永吉 洋介, 河野 博, 森 泰寿, 大内田 研宙, 上田 純二, 高畑 俊一, 石神 康生, 伊藤 鉄英, 五十嵐 久人, 相島 慎一, 大久保 文彦, 水元 一博, 清水 周次, 田中 雅夫

    胆と膵   2012.11

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    【再びIPMNの切除適応を考える】 IPMNに併存する通常型膵癌の診断をどうするか?
    膵管内乳頭粘液性腫瘍(IPMN:intraductal papillary mucinous neoplasm)の3~10&#37;に通常型膵管癌を合併することが報告されており、IPMNを通常型膵癌のハイリスク群として重点的に精査し、経過観察を行うことで併存膵癌を早期に診断できる可能性がある。IPMNの初診時および切除時にはendoscopic retrograde pancreatograhpu(ERP)下膵液細胞診と術中膵管洗浄細胞診が、他の画像診断法では捉えられない早期の併存膵癌の同定に有用である。一方、IPMNの経過観察中に早期の併存PDACを診断するためのサーベイランス法とERPの位置づけは確立されておらず、今後急ぎ検討すべき課題である。(著者抄録)

  • 【CT・MRI造影剤使用のためのA to Z】 MRI用細胞外液性造影剤の体内動態とそれに基づく造影剤の投与法 体幹部(心臓、大血管を除く)

    高山 幸久, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 藤田 展宏, 本田 浩

    臨床画像   2012.11

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    【CT・MRI造影剤使用のためのA to Z】 MRI用細胞外液性造影剤の体内動態とそれに基づく造影剤の投与法 体幹部(心臓、大血管を除く)

  • 肝細胞癌におけるapelin/APJ系を介した新しい血管新生阻害療法に関する基礎的研究(Apelin/APJ system could be a new target of anti- angiogenic therapy against hepatocellular carcinoma)

    武藤 純, 調 憲, 吉屋 匠平, 的野 る美, 戸島 剛男, 播本 憲史, 山下 洋一, 池上 徹, 吉住 朋晴, 副島 雄二, 石神 康生, 前原 喜彦

    日本癌学会総会記事   2012.8

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    肝細胞癌におけるapelin/APJ系を介した新しい血管新生阻害療法に関する基礎的研究(Apelin/APJ system could be a new target of anti- angiogenic therapy against hepatocellular carcinoma)

  • 【感染症の画像診断:早期に診断し、治療する】 腹部感染症 上腹部実質臓器・消化管

    牛島 泰宏, 西江 昭弘, 浅山 良樹, 石神 康生, 柿原 大輔, 高山 幸久, 藤田 展宏, 本田 浩

    臨床画像   2012.4

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    【感染症の画像診断:早期に診断し、治療する】 腹部感染症 上腹部実質臓器・消化管

  • 【腹部のcommon diseaseの画像スペクトラム-良性疾患も多岐多彩-】 肝嚢胞・肝海綿状血管腫

    藤田 展宏, 西江 昭弘, 浅山 良樹, 石神 康生, 柿原 大輔, 牛島 泰宏, 高山 幸久, 本田 浩

    画像診断   2012.3

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    【腹部のcommon diseaseの画像スペクトラム-良性疾患も多岐多彩-】 肝嚢胞・肝海綿状血管腫

  • 膵管内進展を呈した膵腺房細胞癌の1例

    大嶋 かおり, 石神 康生, 田嶋 強, 西江 昭弘, 浅山 良樹, 中山 智博, 高山 幸久, 本田 浩, 柿原 大輔, 中村 雅史, 高畑 俊一, 藤田 展宏

    Japanese Journal of Radiology   2012.2

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    膵管内進展を呈した膵腺房細胞癌の1例

  • FDG-PETにて高集積を呈した膵solid-pseudopapillary tumorの1例

    丸岡 保博, 阿部 光一郎, 馬場 眞吾, 澤本 博史, 田邉 祥孝, 石神 康生, 田嶋 強, 本田 浩, 佐々木 雅之, 藤田 展宏

    Japanese Journal of Radiology   2012.2

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    FDG-PETにて高集積を呈した膵solid-pseudopapillary tumorの1例

  • 切除不能肝内胆管細胞癌に対するゲムシタビン併用シスプラチン肝動脈化学塞栓術の検討

    平川 雅和, 坂本 勝美, 渥美 和重, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 本田 浩

    日本医学放射線学会学術集会抄録集   2012.2

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    切除不能肝内胆管細胞癌に対するゲムシタビン併用シスプラチン肝動脈化学塞栓術の検討

  • 肝内胆管癌のGd-EOB-DTPA造影MRI所見の検討 低分化肝細胞癌との対比

    浅山 良樹, 西江 昭弘, 石神 康生, 柿原 大輔, 牛島 泰宏, 高山 幸久, 藤田 展宏, 調 憲, 久保 雄一郎, 相島 慎一

    日本医学放射線学会学術集会抄録集   2012.2

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    肝内胆管癌のGd-EOB-DTPA造影MRI所見の検討 低分化肝細胞癌との対比

  • 胆管内乳頭状腫瘍(IPN-B)の1例

    染原 涼, 中山 智博, 田嶋 強, 西江 昭弘, 浅山 良樹, 石神 康生, 柿原 大輔, 岡本 大佑, 本田 浩, 調 憲, 武冨 紹信, 藤田 展宏

    Japanese Journal of Radiology   2012.2

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    胆管内乳頭状腫瘍(IPN-B)の1例

  • 腎盂癌の検出におけるMRI拡散強調像の有用性

    牛島 泰宏, 西江 昭弘, 浅山 良樹, 石神 康生, 柿原 大輔, 高山 幸久, 藤田 展宏, 久保 雄一郎, 内藤 誠二, 本田 浩

    日本医学放射線学会学術集会抄録集   2012.2

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    腎盂癌の検出におけるMRI拡散強調像の有用性

  • 膵漿液性嚢胞腫瘍の画像所見の再検討 粘液性嚢胞腫瘍や膵管内乳頭粘液性腫瘍との鑑別上の問題点

    石神 康生, 西江 昭弘, 浅山 良樹, 柿原 大輔, 牛島 泰宏, 高山 幸久, 藤田 展宏, 高畑 俊一, 伊藤 鉄英, 本田 浩

    日本医学放射線学会学術集会抄録集   2012.2

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    膵漿液性嚢胞腫瘍の画像所見の再検討 粘液性嚢胞腫瘍や膵管内乳頭粘液性腫瘍との鑑別上の問題点

  • 【混合型肝癌および胆管形質を示す肝細胞癌:肝ステム細胞のインパクト】 混合型肝癌(新WHO分類を中心に) サブタイプ 細胆管癌の臨床・画像診断

    浅山 良樹, 西江 昭弘, 石神 康生, 柿原 大輔, 牛島 泰宏, 高山 幸久, 藤田 展宏, 本田 浩

    肝・胆・膵   2011.10

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    【混合型肝癌および胆管形質を示す肝細胞癌:肝ステム細胞のインパクト】 混合型肝癌(新WHO分類を中心に) サブタイプ 細胆管癌の臨床・画像診断

  • 膜の局所解剖と画像診断:腹膜・筋膜に沿った病変の進展

    石神康生、西江昭弘、浅山良樹、柿原大輔、牛島泰宏、高山幸久、藤田展宏、森山智彦、本田 浩

    画像診断 2011;31(12):1168-1176.   2011.10

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  • 腎腫瘤の鑑別診断 嚢胞性腎腫瘤

    石神 康生

    日本医学放射線学会秋季臨床大会抄録集   2011.9

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    腎腫瘤の鑑別診断 嚢胞性腎腫瘤

  • 【膜の局所解剖と画像診断】 腹膜・筋膜に沿った病変の進展

    石神 康生, 西江 昭弘, 浅山 良樹, 柿原 大輔, 牛島 泰宏, 高山 幸久, 藤田 展宏, 森山 智彦, 本田 浩

    画像診断   2011.9

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    【膜の局所解剖と画像診断】 腹膜・筋膜に沿った病変の進展

  • 当科で経験した小膵癌6症例の検討

    下川 雄三, 五十嵐 久人, 内田 匡彦, 肱岡 真之, 新名 雄介, 藤森 尚, 中村 太一, 大野 隆真, 中村 雅史, 田中 雅夫, 石神 康生, 小田 義直, 高柳 涼一, 伊藤 鉄英

    膵臓   2011.6

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    当科で経験した小膵癌6症例の検討

  • 【経過を追えた小膵癌 この所見に気をつけろ!】 【症例呈示】 糖尿病と膵癌

    新名 雄介, 五十嵐 久人, 安田 幹彦, 石神 康生, 中村 雅史, 森松 克哉, 小田 義直, 高柳 涼一, 伊藤 鉄英

    肝胆膵画像   2011.5

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    【経過を追えた小膵癌 この所見に気をつけろ!】 【症例呈示】 糖尿病と膵癌
    膵癌は診断時にすでに切除不能であることが多く,早期に診断し,切除可能例を増やすことが予後向上に重要であると考えられる.2009年版,膵癌診療ガイドラインでは膵癌の危険因子の1つとして糖尿病を挙げている.糖尿病の診療に際し,新規発症例(特に高齢発症例)や誘因のない血糖コントロールの急激な悪化例などに対しては膵癌を念頭に置き,積極的に腹部USや腹部造影CTなどを行う必要がある.小膵癌の場合,腫瘤自体の描出は困難であることもあるが,主膵管拡張や小嚢胞などの間接所見を見逃さずにEUSやERCPなどのさらなる精査を行うことで膵癌といえども早期発見につながる可能性がある.(著者抄録)

    DOI: 10.11477/mf.1428100392

  • 【All About Gd-EOB-DTPA MRI】 肝障害とEOB取り込み

    西江 昭弘, 浅山 良樹, 石神 康生, 柿原 大輔, 中山 智博, 高山 幸久, 本田 浩, 藤田 展宏

    臨床画像   2011.3

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    【All About Gd-EOB-DTPA MRI】 肝障害とEOB取り込み

  • 胆道画像診断のコンセンサス:良性胆管狭窄

    石神康生、西江昭弘、浅山良樹、中山智博、柿原大輔、高山幸久、伊藤鉄英、五十嵐久人、高畑俊一、本田 浩

    画像診断 2011;31(3):305-315   2011.3

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  • 画像的に脾組織が同定困難な類表皮嚢胞と膵粘液性嚢胞性腫瘍との画像所見の比較

    石神 康生, 西江 昭弘, 入江 裕之, 浅山 良樹, 柿原 大輔, 中山 智博, 高山 幸久, 中村 雅史, 伊藤 鉄英, 本田 浩

    日本医学放射線学会学術集会抄録集   2011.2

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    画像的に脾組織が同定困難な類表皮嚢胞と膵粘液性嚢胞性腫瘍との画像所見の比較

  • 【胆道画像診断のコモンセンス】 良性胆管狭窄

    石神 康生, 西江 昭弘, 浅山 良樹, 中山 智博, 柿原 大輔, 高山 幸久, 伊藤 鉄英, 五十嵐 久人, 高畑 俊一, 本田 浩

    画像診断   2011.2

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    【胆道画像診断のコモンセンス】 良性胆管狭窄

  • 副腎皮質過形成のdynamic CT所見の解析 washoutを中心に

    西江 昭弘, 浅山 良樹, 石神 康生, 柿原 大輔, 中山 智博, 高山 幸久, 内藤 誠二, 藤田 展宏, 本田 浩

    日本医学放射線学会学術集会抄録集   2011.2

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    副腎皮質過形成のdynamic CT所見の解析 washoutを中心に

  • 動脈性消化管出血に対する動脈塞栓術の有用性についての検討

    浅山 良樹, 西江 昭弘, 石神 康生, 柿原 大輔, 中山 智博, 高山 幸久, 本田 浩

    日本医学放射線学会学術集会抄録集   2011.2

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    動脈性消化管出血に対する動脈塞栓術の有用性についての検討

  • 拡散強調画像の有用性が示唆された肝硬化性血管腫の1例

    樋田 知之, 西江 昭弘, 田嶋 強, 浅山 良樹, 石神 康生, 牛島 泰宏, 柿原 大輔, 本田 浩, 相島 慎一, 武冨 紹信

    Japanese Journal of Radiology   2011.1

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    拡散強調画像の有用性が示唆された肝硬化性血管腫の1例

  • BCG膀胱注入療法に伴う腎肉芽腫の1例

    藤田 陽子, 柿原 大輔, 田嶋 強, 西江 昭弘, 浅山 良樹, 石神 康生, 中山 智博, 岡本 大佑, 本田 浩, 多田 靖弘, 内藤 誠二, 藤田 展宏

    Japanese Journal of Radiology   2011.1

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    BCG膀胱注入療法に伴う腎肉芽腫の1例

  • 腎細胞癌と鑑別が困難であった黄色肉芽腫性腎盂腎炎の1例

    田島 歓子, 柿原 大輔, 田嶋 強, 西江 昭弘, 石神 康生, 牛島 泰宏, 本田 浩, 内藤 誠二, 関 成人, 藤田 忠明

    Japanese Journal of Radiology   2010.7

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    腎細胞癌と鑑別が困難であった黄色肉芽腫性腎盂腎炎の1例

  • MRI拡散強調像で高信号を呈した膵リンパ上皮性嚢胞の1例

    岡本 大佑, 石神 康生, 吉満 研吾, 田嶋 強, 西江 昭弘, 平川 雅和, 牛島 泰宏, 本田 浩, 山口 幸二, 長田 盛典

    Japanese Journal of Radiology   2010.7

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    MRI拡散強調像で高信号を呈した膵リンパ上皮性嚢胞の1例

  • Contrast Enhanced MDCT(Season 4) 領域別に見るMDCTの検査・診断up-to-date(Vol.03) 腹部領域 上腹部領域における64列MDCTの有用性 肝臓を中心に

    西江 昭弘, 田嶋 強, 浅山 良樹, 石神 康生, 柿原 大輔, 中山 智博, 高山 幸久, 本田 浩

    INNERVISION   2010.6

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    Contrast Enhanced MDCT(Season 4) 領域別に見るMDCTの検査・診断up-to-date(Vol.03) 腹部領域 上腹部領域における64列MDCTの有用性 肝臓を中心に
    multidetector-row CT(MDCT)が登場したのは十数年前であるが、その後MDCTは多列化し、現在では128~320列の検出器を持ったCTも臨床使用されている。多列MDCTの画像は、空間分解能が高く、isotropic imageのため三次元再構成が可能で、任意の方向から関心領域を観察できる利点がある。一方で、時間分解能にも優れており、呼吸性移動の影響を受けにくく、撮影タイミングの違いや遅れで診断が難しい病変にも対応が可能となった。これは、心・大血管領域だけでなく、腹部領域でも非常に有用と考えられる。本稿では、上腹部、特に肝臓領域における64列MDCTの有用性と、実際の臨床的な活用法について例を挙げて概説する。(著者抄録)

  • エピネフリン動注下TACEが奏効した胆管内発育肝細胞癌の1例

    轟木 渉, 田嶋 強, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 柿原 大輔, 本田 浩, 武冨 紹信

    IVR: Interventional Radiology   2010.4

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    エピネフリン動注下TACEが奏効した胆管内発育肝細胞癌の1例

  • 【最新分類に基づく画像による悪性腫瘍の病期診断2010】 膵

    石神 康生, 田嶋 強, 平川 雅和, 西江 昭弘, 浅山 良樹, 柿原 大輔, 中山 智博, 岡本 大佑, 本田 浩

    臨床画像   2010.4

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    【最新分類に基づく画像による悪性腫瘍の病期診断2010】 膵

  • Lipomatous pseudohypertrophy of the pancreas(LPP)の一症例

    安田 幹彦, 伊藤 鉄英, 五十嵐 久人, 新名 雄介, 内田 匡彦, 藤森 尚, 中村 太一, 大野 隆真, 石神 康生, 高柳 涼一

    日本消化器病学会雑誌   2010.3

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    Lipomatous pseudohypertrophy of the pancreas(LPP)の一症例

  • 生体肝移植症例における肝細胞癌の診断能 dynamic CT、EOB-MRI、CTHA/CTAPの比較

    柿原 大輔, 西江 昭弘, 田嶋 強, 浅山 良樹, 石神 康生, 中山 智博, 岡本 大佑, 武冨 紹信, 藤田 展宏, 本田 浩

    日本医学放射線学会学術集会抄録集   2010.2

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    生体肝移植症例における肝細胞癌の診断能 dynamic CT、EOB-MRI、CTHA/CTAPの比較

  • SPIO-MRIで認められる肝細胞癌辺縁部のT2*短縮域について

    石神 康生, 藤田 展宏, 田嶋 強, 西江 昭弘, 浅山 良樹, 柿原 大輔, 中山 智博, 岡本 大佑, 武富 紹信, 本田 浩

    日本医学放射線学会学術集会抄録集   2010.2

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    SPIO-MRIで認められる肝細胞癌辺縁部のT2*短縮域について

  • Gd-EOB-DTPA造影MRI肝細胞相にて造影剤の取り込みを認めた肝細胞癌の検討

    浅山 良樹, 田嶋 強, 西江 昭弘, 石神 康生, 柿原 大輔, 中山 智博, 岡本 大佑, 調 憲, 藤田 展宏, 本田 浩

    日本医学放射線学会学術集会抄録集   2010.2

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    Gd-EOB-DTPA造影MRI肝細胞相にて造影剤の取り込みを認めた肝細胞癌の検討

  • Gd-EOB-DTPA造影MRIを用いた肝機能の評価 肝受容体シンチとの比較

    西江 昭弘, 牛島 泰宏, 田嶋 強, 浅山 良樹, 石神 康生, 柿原 大輔, 中山 智博, 岡本 大佑, 阿部 光一郎, 本田 浩

    日本医学放射線学会学術集会抄録集   2010.2

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    Gd-EOB-DTPA造影MRIを用いた肝機能の評価 肝受容体シンチとの比較

  • 膵腫瘤の画像診断

    石神 康生, 本田 浩

    日本医事新報   2009.11

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    膵腫瘤の画像診断

  • グラフ 膵腫瘤の画像診断

    石神 康生, 本田 浩

    日本医事新報   2009.11

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  • 肝動脈化学塞栓療法(TACE) (特集 ENBD・RFA・PEG・ESD、etc…… 消化器外科の手術以外の治療17)

    石神 康生, 田嶋 強, 西江 昭弘

    消化器外科nursing   2009.7

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  • 【ENBD・RFA・PEG・ESD、etc 消化器外科の手術以外の治療17】 肝動脈化学塞栓療法(TACE)

    石神 康生, 田嶋 強, 西江 昭弘, 浅山 良樹, 牛島 泰宏, 柿原 大輔, 本田 浩

    消化器外科Nursing   2009.7

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    【ENBD・RFA・PEG・ESD、etc 消化器外科の手術以外の治療17】 肝動脈化学塞栓療法(TACE)

  • 【ENBD・RFA・PEG・ESD、etc 消化器外科の手術以外の治療17】 経皮経肝門脈塞栓術(PTPE)

    石神 康生, 田嶋 強, 西江 昭弘, 浅山 良樹, 牛島 泰宏, 柿原 大輔, 本田 浩

    消化器外科Nursing   2009.7

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    【ENBD・RFA・PEG・ESD、etc 消化器外科の手術以外の治療17】 経皮経肝門脈塞栓術(PTPE)

  • 経皮経肝門脈塞栓術(PTPE) (特集 ENBD・RFA・PEG・ESD、etc…… 消化器外科の手術以外の治療17)

    石神 康生, 田嶋 強, 西江 昭弘

    消化器外科nursing   2009.7

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  • 過去の治療によるS4肝実質の萎縮・線維化が原因と思われた肝動脈一本化の不成功例 肝動注リザーバー留置術における注意点

    牛島 泰宏, 吉満 研吾, 入江 裕之, 田嶋 強, 西江 昭弘, 平川 雅和, 石神 康生, 岡本 大佑, 本田 浩

    Japanese Journal of Radiology   2009.4

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    過去の治療によるS4肝実質の萎縮・線維化が原因と思われた肝動脈一本化の不成功例 肝動注リザーバー留置術における注意点

  • 【肝細胞癌の画像診断と病理・病態 現状と将来展望】 特殊な病理像を示す肝細胞癌の画像と病理

    柿原 大輔, 田嶋 強, 藤田 展宏, 浅山 良樹, 西江 昭弘, 石神 康生, 牛島 泰宏, 本田 浩, 吉満 研吾

    画像診断   2009.4

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    【肝細胞癌の画像診断と病理・病態 現状と将来展望】 特殊な病理像を示す肝細胞癌の画像と病理

  • 【肝細胞癌の画像診断と病理・病態 現状と将来展望】 肝細胞癌脈管浸潤の画像診断と病理

    西江 昭弘, 田嶋 強, 藤田 展宏, 浅山 良樹, 石神 康生, 牛島 泰宏, 柿原 大輔, 岡本 大佑, 武冨 紹信, 本田 浩

    画像診断   2009.4

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    【肝細胞癌の画像診断と病理・病態 現状と将来展望】 肝細胞癌脈管浸潤の画像診断と病理

  • 塊状の限局性リンパ球集簇を含有する後腹膜脂肪肉腫の一例

    川野 倫作, 西江 昭弘, 吉満 研吾, 入江 裕之, 田嶋 強, 平川 雅和, 石神 康生, 牛島 泰宏, 岡本 大佑, 本田 浩, 西原 雄之介, 武富 紹信

    Japanese Journal of Radiology   2009.4

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    塊状の限局性リンパ球集簇を含有する後腹膜脂肪肉腫の一例

  • 腎細胞癌の予後予測におけるMRIの有用性

    柿原 大輔, 西江 昭弘, 田嶋 強, 浅山 良樹, 石神 康生, 牛島 泰宏, 岡本 大佑, 内藤 誠二, 藤田 展宏, 本田 浩

    日本医学放射線学会学術集会抄録集   2009.2

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    腎細胞癌の予後予測におけるMRIの有用性

  • Groove膵癌とGroove膵炎の画像所見の比較 門脈相における鑑別の検討

    石神 康生, 田嶋 強, 柿原 大輔, 西江 昭弘, 浅山 良樹, 牛島 泰宏, 本田 浩, 中村 雅史, 伊藤 鉄英, 藤田 展宏

    日本医学放射線学会学術集会抄録集   2009.2

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    Groove膵癌とGroove膵炎の画像所見の比較 門脈相における鑑別の検討

  • SPIO(super paramagnetic iron oxide)-MRIを用いた肝機能の定量的評価 肝受容体シンチとの比較

    西江 昭弘, 田嶋 強, 浅山 良樹, 石神 康生, 牛島 泰宏, 柿原 大輔, 阿部 光一郎, 吉満 研吾, 奥秋 知幸, 本田 浩

    日本医学放射線学会学術集会抄録集   2009.2

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    SPIO(super paramagnetic iron oxide)-MRIを用いた肝機能の定量的評価 肝受容体シンチとの比較

  • 小児肝芽腫に対するTACEの安全性と治療成績

    平川 雅和, 田嶋 強, 西江 昭弘, 石神 康生, 牛島 泰宏, 柿原 大輔, 藤田 展宏, 田尻 達郎, 田口 智章, 本田 浩

    日本医学放射線学会学術集会抄録集   2009.2

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    小児肝芽腫に対するTACEの安全性と治療成績

  • 肝細胞癌TACE後のマージン判定における3D CTHA/CT Fusion画像の有用性

    田嶋 強, 柿原 大輔, 西江 昭弘, 浅山 良樹, 石神 康生, 牛島 泰宏, 岡本 大祐, 本田 浩

    日本医学放射線学会学術集会抄録集   2009.2

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    肝細胞癌TACE後のマージン判定における3D CTHA/CT Fusion画像の有用性

  • 症例 CTガイド下ラジオ波焼灼療法で治療した類骨骨腫の一例

    野元 麻子, 平川 雅和, 吉満 研吾, 入江 裕之, 田嶋 強, 西江 昭弘, 石神 康生, 牛島 泰宏, 岡本 大佑, 山田 泉

    福岡医学雑誌   2008.10

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    CT-guided radiofrequency ablation for osteoid osteoma
    Osteoid osteoma is a benign bone tumor traditionally treated nonoperatively or by operative excision. However, radiofrequency ablation (RFA) is being used increasingly for treatment of osteoid osteoma, as there are several reports supporting its effectiveness. We present a case of osteoid osteoma of femur in an 18-year-old boy. The patient complained of pain in right hip and knee joint. The osteoid osteoma lesion was successfully treated by percutaneous computed tomography (CT)-guided RFA using the cool-tip RFA system under general anesthesia. He had total pain relief within 24 hours following the procedure. No complications were recorded. He discharged on foot two days after RFA therapy. Complete regression of symptoms was observed at 2-year follow-up. CT-guided RFA for osteoid osteoma is a safe, effective and minimally invasive procedure with high success rate and lack of relapse.

    DOI: 10.15017/12842

  • CTガイド下ラジオ波焼灼療法で治療した類骨骨腫の一例

    野元 麻子, 平川 雅和, 吉満 研吾, 入江 裕之, 田嶋 強, 西江 昭弘, 石神 康生, 牛島 泰宏, 岡本 大佑, 山田 泉, 本田 浩

    福岡医学雑誌   2008.10

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    CTガイド下ラジオ波焼灼療法で治療した類骨骨腫の一例
    18歳男。9ヵ月前からの右股関節痛・右膝痛を主訴として近医を受診した。臨床所見および画像検査から、右大腿骨類骨骨腫と診断され、CTガイド下ラジオ波焼灼療法(RFA)目的で紹介受診した。ガドリニウム造影では増強効果を認め、類骨骨腫のnidusと考えた。MRIの脂肪抑制T2強調画像冠状断では、nidus周囲に高信号域を認め、周囲の浮腫性変化と考えた。CTガイド下RFAは全身麻酔下に仰臥位で施行した。術中術後に合併症を認めなかった。治療翌日より鎮痛剤の内服なしでVASは0点となり、治療2日後に独歩で退院した。治療3ヵ月後には臨床症状の再発は認めず、MRI上もnidusの増強効果はほぼ消失し、周囲の浮腫性変化も不明瞭化した。治療後2年経過後も症状の再発を認めていない。

    DOI: 10.15017/12842

  • 【ER必携 腹痛の画像診断】 急性腹症の画像診断 出血

    牛島 泰宏, 田嶋 強, 西江 昭弘, 石神 康生, 柿原 大輔, 岡本 大佑, 本田 浩

    画像診断   2008.10

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    【ER必携 腹痛の画像診断】 急性腹症の画像診断 出血

  • 副腎腫瘍の鑑別診断

    吉満 研吾, 田嶋 強, 西江 昭弘, 石神 康生, 牛島 泰宏, 柿原 大輔, 本田 浩

    臨床放射線   2008.9

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    副腎腫瘍の鑑別診断

  • SPIO投与前後での肝のT2*およびT2 mapping 肝機能との関連について

    吉満 研吾, 田嶋 強, 西江 昭弘, 石神 康生, 牛島 泰宏, 柿原 大輔, 本田 浩, 奥秋 知幸, 斎木 秀太郎, マルク・ヴァン・カウテレン

    映像情報Medical   2008.8

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    SPIO投与前後での肝のT2*およびT2 mapping 肝機能との関連について

  • 膀胱に発生したsolitary fibrous tumorの1例

    柿原 大輔, 吉満 研吾, 入江 裕之, 田嶋 強, 浅山 良樹, 平川 雅和, 石神 康生, 本田 浩, 古賀 寛史, 西原 雄之介

    Radiation Medicine   2008.4

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    膀胱に発生したsolitary fibrous tumorの1例

  • 卵巣未熟奇形腫に認められた腹膜神経膠腫症の一例

    岡本 大祐, 石神 康生, 吉満 研吾, 入江 裕之, 田嶋 強, 浅山 良樹, 平川 雅和, 本田 浩, 西原 雄之介, 尼田 覚

    Radiation Medicine   2008.4

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    卵巣未熟奇形腫に認められた腹膜神経膠腫症の一例

  • 胆道閉鎖症術後における肝の形態変化について

    石神 康生, 吉満 研吾, 入江 裕之, 田嶋 強, 西江 昭弘, 平川 雅和, 牛島 泰宏, 岡本 大佑, 西本 祐子, 本田 浩

    日本医学放射線学会学術集会抄録集   2008.2

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    胆道閉鎖症術後における肝の形態変化について

  • SPIO-MRIによる肝細胞癌の検出能 拡散強調画像の付加価値

    西江 昭弘, 吉満 研吾, 入江 裕之, 田嶋 強, 平川 雅和, 石神 康生, 牛島 泰宏, 西原 雄之介, 武冨 紹信, 本田 浩

    日本医学放射線学会学術集会抄録集   2008.2

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    SPIO-MRIによる肝細胞癌の検出能 拡散強調画像の付加価値

  • 多血性肝細胞癌のdynamic MR washoutパターンと病理所見の関係について

    岡本 大佑, 吉満 研吾, 入江 裕之, 田嶋 強, 西江 昭弘, 平川 雅和, 石神 康生, 牛島 泰宏, 本田 浩, 西原 雄之介

    日本医学放射線学会学術集会抄録集   2008.2

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    多血性肝細胞癌のdynamic MR washoutパターンと病理所見の関係について

  • 尾状葉肝細胞癌に対する経血管的治療の治療成績

    平川 雅和, 田嶋 強, 吉満 研吾, 入江 裕之, 西江 昭弘, 石神 康生, 牛島 泰宏, 岡本 大佑, 本田 浩

    日本医学放射線学会学術集会抄録集   2008.2

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    尾状葉肝細胞癌に対する経血管的治療の治療成績

  • 肝細胞癌の血管内治療におけるCone-beam CTの有用性 結節および栄養血管の検出能

    牛島 泰宏, 田嶋 強, 吉満 研吾, 入江 裕之, 西江 昭弘, 平川 雅和, 石神 康生, 岡本 大祐, 本田 浩

    日本医学放射線学会学術集会抄録集   2008.2

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    肝細胞癌の血管内治療におけるCone-beam CTの有用性 結節および栄養血管の検出能

  • 【膵臓外科の新たな展開】 IPMNの手術適応と治療成績

    山口 幸二, 家永 淳, 堤 宏介, 大内田 研宙, 外園 幸司, 田邊 麗子, 佐藤 典宏, 当間 宏樹, 高畑 俊一, 中村 雅史, 伊藤 鉄英, 石神 康生, 恒吉 正澄, 田中 雅夫

    臨床外科   2007.12

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    【膵臓外科の新たな展開】 IPMNの手術適応と治療成績
    膵管内乳頭粘液性腫瘍(IPMN)は,腺腫より境界病変,粘膜内癌,微小浸潤癌,IPMN由来の浸潤癌へと連続する病変と考えられている.境界病変(粘膜内癌)以上が手術適応で,腺腫は経過観察とする.術前異型度診断が粘膜内癌の診断では膵頭十二指腸第2部切除や膵分節切除などの膵縮小手術の適応となる.浸潤癌の診断ではD2リンパ節郭清を伴う膵切除の適応となる.IPMNでは周辺の膵管に異型上皮の進展を認めるので,膵断端の術中迅速診断での検索は必要で,高度以上の異型上皮では追加切除の適応となる.異時性,同時性の他臓器癌や浸潤性膵管癌の併存にはIPMN診断時や経過観察などで注意する必要がある.(著者抄録)

    DOI: 10.11477/mf.1407101964

  • 【肝胆膵の画像診断 最近の進歩】 MRIによる胆膵の診断

    吉満 研吾, 入江 裕之, 田嶋 強, 西江 昭弘, 平川 雅和, 石神 康生, 牛嶋 泰宏, 本田 浩

    画像診断   2007.10

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    【肝胆膵の画像診断 最近の進歩】 MRIによる胆膵の診断

  • 【肝胆膵における画像診断の新展開】 膵臓疾患に対する新展開 炎症性疾患 膵のCT/MRI診断

    西江 昭弘, 吉満 研吾, 入江 裕之, 田嶋 強, 平川 雅和, 石神 康生, 牛島 泰宏, 岡本 大祐, 本田 浩

    肝・胆・膵   2007.10

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    【肝胆膵における画像診断の新展開】 膵臓疾患に対する新展開 炎症性疾患 膵のCT/MRI診断

  • 【癌における画像診断の進歩】 胆膵悪性腫瘍における画像診断の進歩

    入江 裕之, 吉満 研吾, 田嶋 強, 西江 昭弘, 平川 雅和, 石神 康生, 牛島 泰宏, 岡本 大佑, 本田 浩

    癌と化学療法   2007.9

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    【癌における画像診断の進歩】 胆膵悪性腫瘍における画像診断の進歩
    マルチスライスCTの検出器の多列化は、等方性ボクセルを可能とし、理想的な三次元画像が容易に得られるようなった。高画質のCTAやMPRは胆膵疾患の診断に有用であり、curved-MPR像は胆膵悪性腫瘍の診断能を向上させた。MRIでは三次元データ収集法がルーチン撮像法となり、三次元ダイナミックスタディや三次元MRCPが胆膵疾患の診断にもたらす効果は大きい。拡散強調像も胆膵領域に臨床応用可能となり、膵癌などの診断にその有用性が期待されている。(著者抄録)

  • 【分枝型IPMNの長期経過と手術適応】 分枝型IPMNと浸潤性膵管癌の併存ならびに鑑別

    山口 幸二, 家永 淳, 外園 幸司, 田邊 麗子, 大内田 研宙, 当間 宏樹, 高畑 俊一, 佐藤 典宏, 中村 雅史, 石神 康生, 河邊 毅, 恒吉 正澄, 田中 雅夫

    胆と膵   2007.9

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    【分枝型IPMNの長期経過と手術適応】 分枝型IPMNと浸潤性膵管癌の併存ならびに鑑別
    分枝型IPMNにはIPMNと離れた膵管より膵管癌が発生しうる(IPMN併存の膵管癌)。一方、IPMNは微小浸潤癌よりIPMN由来の浸潤癌へと進展する(IPMN由来の浸潤癌)。IPMN由来の浸潤癌ではIPMNより浸潤癌への移行像が認められることが必要である。IPMN併存の膵管癌が、IPMNと近接、もしくは一部接するとIPMN由来の浸潤癌との鑑別が困難となる。また、IPMN由来の浸潤癌も浸潤癌部が大きくなって、IPMN由来の根拠となっている移行像が破壊され、移行像が示されなくなった例も存在する。そうした例では移行像がないため、IPMN併存の膵管癌との鑑別が困難となる。IPMN併存の膵管癌とIPMN由来の浸潤癌とはその臨床病理学的特徴が明らかにされていないので、厳密な定義を満たす例に限って、検討を進めていく必要がある。(著者抄録)

  • 【あなたのそばにもIPMN】 IPMNには通常型膵癌が合併する

    山口 幸二, 家永 淳, 田邊 麗子, 大内田 研宙, 高畑 俊一, 当間 宏樹, 佐藤 典宏, 中村 雅史, 石神 康生, 伊藤 鉄英, 恒吉 正澄, 田中 雅夫

    消化器内視鏡   2007.8

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    【あなたのそばにもIPMN】 IPMNには通常型膵癌が合併する
    膵管内乳頭粘液性腫瘍(IPMN)は、他臓器癌を20~30&#37;に認めることが報告され、特に胃癌、大腸癌の合併が多いことが知られている。また、IPMNとは離れた膵管に通常型膵管癌が合併する。自験例IPMN111例では12例に通常型膵管癌が合併していた。そうしたIPMNは、高齢男性の4cm以下の分枝型IPMNで、腺腫であった。IPMN合併の膵癌には、粘膜内癌を含む早期(小)膵癌が多く含まれていた。高齢、男性の4cm以下の分枝型IPMNでは同時性、もしくは異時性の膵癌の合併に注意する必要がある。(著者抄録)

  • 【IPMNと通常型膵管癌の合併は稀か?】 IPMNと通常型膵管癌の合併

    山口 幸二, 家永 淳, 田邊 麗子, 中村 雅史, 佐藤 典宏, 高畑 俊一, 当間 宏樹, 石神 康生, 伊藤 鉄英, 恒吉 正澄, 田中 雅夫

    消化器画像   2007.7

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    【IPMNと通常型膵管癌の合併は稀か?】 IPMNと通常型膵管癌の合併

    DOI: 10.11477/mf.1427100592

  • 【画像診断医のための膵炎のすべて】 自己免疫性膵炎 病理、画像所見から治療まで

    入江 裕之, 吉満 研吾, 田嶋 強, 浅山 良樹, 西江 昭弘, 平川 雅和, 石神 康生, 牛島 泰宏, 岡本 大祐, 本田 浩

    臨床画像   2007.5

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    【画像診断医のための膵炎のすべて】 自己免疫性膵炎 病理、画像所見から治療まで

  • 術後15年に再発した卵巣癌の一例

    篠藤 誠, 石神 康生, 吉満 研吾, 入江 裕之, 田島 強, 浅山 良樹, 平川 雅和, 中山 智博, 柿原 大輔, 藪内 英剛, 本田 浩

    Radiation Medicine   2007.4

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    術後15年に再発した卵巣癌の一例

  • 【閉塞性黄疸の画像診断】 MDCT検査

    石神 康生, 入江 裕之, 吉満 研吾, 柿原 大輔, 田嶋 強, 西江 昭弘, 浅山 良樹, 平川 雅和, 牛島 泰宏, 岡本 大佑, 本田 浩

    臨床画像   2007.4

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    【閉塞性黄疸の画像診断】 MDCT検査

  • 中心性瘢痕を伴った肝細胞癌の一例

    山内 まどか, 浅山 良樹, 吉満 研吾, 入江 裕之, 田嶋 強, 平川 雅和, 石神 康生, 中山 智博, 柿原 大輔, 本田 浩

    Radiation Medicine   2007.4

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    中心性瘢痕を伴った肝細胞癌の一例

  • 悪性黒色腫の胆嚢転移の一例

    高山 幸久, 浅山 良樹, 吉満 研吾, 入江 裕之, 田嶋 強, 石神 康生, 平川 雅和, 柿原 大輔, 本田 浩, 杉谷 篤, 師井 洋一, 江口 孝志

    Radiation Medicine   2007.4

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    悪性黒色腫の胆嚢転移の一例

  • 膵腎同時移植術後、腎動脈狭窄をきたした1例

    北田 秀久, 杉山 篤, 岡部 安博, 大田 守仁, 吉田 淳一, 土井 篤, 西岡 泰信, 田嶋 強, 石神 康生, 田中 雅夫

    移植   2007.4

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    膵腎同時移植術後、腎動脈狭窄をきたした1例

  • 非典型的あるいはユニークな画像所見を呈した胃癌転移再発症例と胃癌類似の画像所見を呈した症例

    石神 康生, 吉満 研吾, 入江 裕之, 田嶋 強, 平川 雅和, 牛島 泰宏, 宇都宮 尚, 井野 彰浩, 平田 文, 本田 浩

    日本医学放射線学会学術集会抄録集   2007.2

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    非典型的あるいはユニークな画像所見を呈した胃癌転移再発症例と胃癌類似の画像所見を呈した症例

  • 【急性腹症の画像診断 最近の考え方】 肝胆膵疾患による急性腹症

    浅山 良樹, 吉満 研吾, 入江 裕之, 田嶋 強, 平川 雅和, 石神 康生, 牛島 泰宏, 本田 浩

    画像診断   2007.2

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    【急性腹症の画像診断 最近の考え方】 肝胆膵疾患による急性腹症

  • 子宮頸癌患者における卵巣移動術後の卵巣静脈のMDCTでの検出能

    平川 雅和, 吉満 研吾, 入江 裕之, 田嶋 強, 石神 康生, 牛島 泰彦, 岡本 大祐, 本田 浩

    日本医学放射線学会学術集会抄録集   2007.2

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    子宮頸癌患者における卵巣移動術後の卵巣静脈のMDCTでの検出能

  • 肝鎌状靱帯動脈の描出頻度と臨床的意義 血管造影、ダイナミックCT、動注CTにおける比較

    田嶋 強, 吉満 研吾, 入江 裕之, 平川 雅和, 石神 康生, 牛島 泰宏, 本田 浩

    日本医学放射線学会学術集会抄録集   2007.2

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    肝鎌状靱帯動脈の描出頻度と臨床的意義 血管造影、ダイナミックCT、動注CTにおける比較

  • 【膵疾患における画像診断の進歩】 膵疾患のMDCT診断

    入江 裕之, 吉満 研吾, 石神 康生, 田嶋 強, 浅山 良樹, 平川 雅和, 牛島 泰宏, 本田 浩

    日本消化器病学会雑誌   2006.12

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    【膵疾患における画像診断の進歩】 膵疾患のMDCT診断
    膵疾患のMDCT診断を行うための必要な知識として、MDCTの特長、膵のダイナミックCT、3次元画像の臨床的有用性について解説した。MDCTの特長は高時間分解能と高空間分解能にあり、それらを利用して得られるボリュームデータは臨床に役立つ3次元画像を提供する。膵のダイナミックCTは膵実質相、門脈相、遅延相の3相撮像が基本であり、適切な撮像開始時間を設定するためには造影剤の血行動態を理解しておくことが重要である。CTAは膵疾患の術前血管造影を不要にし、MPRは膵疾患の診断能を向上させた。さらに主膵管の全長を1画像で表示できるCPRは膵疾患のMDCT診断にはなくてはならない画像となっている。(著者抄録)

    DOI: 10.11405/nisshoshi.103.1333

  • 【病院でよく使われる薬物療法】 造影剤の安全な使用法

    石神 康生, 吉満 研吾, 入江 裕之, 田嶋 強, 浅山 良樹, 平川 雅和, 牛島 泰宏, 岡本 大佑, 本田 浩

    臨牀と研究   2006.9

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    【病院でよく使われる薬物療法】 造影剤の安全な使用法

  • 異常所見を見逃さない読影の秘訣 腹部CT 転移検索などを念頭に

    石神 康生, 入江 裕之, 吉満 研吾, 田嶋 強, 浅山 良樹, 平川 雅和, 柿原 大輔, 本田 浩

    臨床画像   2006.4

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    異常所見を見逃さない読影の秘訣 腹部CT 転移検索などを念頭に

  • 症例で見る造影CTの実際 マルチスライスCTの領域別テクニックシリーズ 腹部領域 肝・膵における検査法とその有用性

    浅山 良樹, 柿原 大輔, 吉満 研吾, 入江 裕之, 田嶋 強, 平川 雅和, 石神 康生, 本田 浩

    INNERVISION   2006.3

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    症例で見る造影CTの実際 マルチスライスCTの領域別テクニックシリーズ 腹部領域 肝・膵における検査法とその有用性

  • 肝癌患者に対する生体肝移植術前画像診断の肝癌診断能 全肝摘出標本との対比

    平川 雅和, 吉満 研吾, 入江 裕之, 田嶋 強, 浅山 良樹, 石神 康生, 柿原 大輔, 本田 浩

    日本医学放射線学会学術集会抄録集   2006.2

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    肝癌患者に対する生体肝移植術前画像診断の肝癌診断能 全肝摘出標本との対比

  • B型・C型肝炎ウィルス感染患者における膵容積の比較 MDCT再構成画像を用いた膵のvolumetry

    田嶋 強, 吉満 研吾, 入江 裕之, 浅山 良樹, 平川 雅和, 石神 康生, 柿原 大輔, 本田 浩

    日本医学放射線学会学術集会抄録集   2006.2

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    Language:Japanese  

    B型・C型肝炎ウィルス感染患者における膵容積の比較 MDCT再構成画像を用いた膵のvolumetry

  • Iliopsoas Grooveおよびその近傍に認められる病変の画像所見

    石神 康生, 吉満 研吾, 入江 裕之, 田嶋 強, 浅山 良樹, 平川 雅和, 柿原 大輔, 本田 浩

    日本医学放射線学会学術集会抄録集   2006.2

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    Iliopsoas Grooveおよびその近傍に認められる病変の画像所見

  • 【肝腫瘍の血流動態診断】 早期肝細胞癌・境界病変の血流動態診断

    吉満 研吾, 田嶋 強, 浅山 良樹, 入江 裕之, 平川 雅和, 石神 康生, 本田 浩

    Radiology Frontier   2006.2

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    【肝腫瘍の血流動態診断】 早期肝細胞癌・境界病変の血流動態診断
    肝細胞癌の多段階発育のうち,早期の段階(境界病変から早期肝細胞癌)における血流状態と病理学的診断の間にはoverlapが多い.肝細胞性結節の血流状態を既存動脈,門脈,新生血管の関係で説明する際,現在の考え方では説明困難な領域の1つである.今回,「早期の新生血管には門脈血流が流れている」との新たな仮説を導入し再度解析を試みた結果,比較的良好な知見が得られたので呈示する.この仮説によれば,門脈血流が周囲よりも増加している結節の存在も理解しやすくなる(著者抄録)

  • 【転移の画像診断】 肝

    篠崎 賢治, 吉満 研吾, 入江 裕之, 田嶋 強, 浅山 良樹, 平川 雅和, 石神 康生, 柿原 大輔, 黒岩 俊郎, 本田 浩

    癌の臨床   2006.2

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    【転移の画像診断】 肝

  • 多時相肝MDCTの差分画像作成における非線形位置補整ソフトの開発

    吉満 研吾, 平松 達雄, 入江 裕之, 田嶋 強, 浅山 良樹, 平川 雅和, 石神 康生, 本田 浩

    日本医学放射線学会学術集会抄録集   2006.2

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    多時相肝MDCTの差分画像作成における非線形位置補整ソフトの開発

  • 【膵疾患 病態に基づく画像診断を目指して】 膵癌のCT/MRIによる検出,鑑別,病期診断

    入江 裕之, 吉満 研吾, 田嶋 強, 浅山 良樹, 平川 雅和, 石神 康生, 柿原 大輔, 本田 浩

    画像診断   2005.12

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    【膵疾患 病態に基づく画像診断を目指して】 膵癌のCT/MRIによる検出,鑑別,病期診断

  • 【胆嚢癌の早期診断の現況と新たな展開】 dynamic MRIによる胆嚢癌の早期診断

    吉満 研吾, 柿原 大輔, 入江 裕之, 田嶋 強, 浅山 良樹, 平川 雅和, 石神 康生, 本田 浩

    胆と膵   2005.10

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    【胆嚢癌の早期診断の現況と新たな展開】 dynamic MRIによる胆嚢癌の早期診断
    胆嚢癌の早期診断におけるdynamic MRの役割は,その高い濃度分解能を活かし,濃染パターンと形態学上の特徴を用いて行う鑑別診断と,隆起性病変の基部における漿膜下浸潤の有無を判定する深達度診断の2つに大別される.対象はUS等によって発見もしくは疑われた病変であり,精査として位置付けられる.具体的には,まず病変と胆嚢そのものの位置関係・オリエンテーションを把握し,病変を評価しやすい断面でdynamic MRを施行することが最も重要な技術的事項である.鑑別疾患においては,病変を隆起型と壁肥厚型にまず分類しそれぞれの鑑別対象疾患を想定して診断する.癌は,新生血管と間質両者を反映する遷延性濃染パターンを呈することで特徴づけられる.ただし,従来から言われている大きさによる因子も充分考慮する.深達度診断では隆起性病変基部での遷延性・遅延性濃染が漿膜下浸潤を示唆する.基部と病変全体が含まれる断面で撮像・評価することが肝要である(著者抄録)

  • 【実地医家のための画像診断実践ガイド CT,MRI,PETをいかに日常診療に利用するか】 実地医家がCT,MRI,PETを日常診療にとり入れるときに必要な基本情報 機器と撮影法の種類 目的による選択法 MRI検査(T1,T2強調像を含めて)

    石神 康生, 吉満 研吾, 入江 裕之, 柿原 大輔, 栂尾 理, 本田 浩

    Medical Practice   2005.10

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    【実地医家のための画像診断実践ガイド CT,MRI,PETをいかに日常診療に利用するか】 実地医家がCT,MRI,PETを日常診療にとり入れるときに必要な基本情報 機器と撮影法の種類 目的による選択法 MRI検査(T1,T2強調像を含めて)

  • 【医療環境の変化に対して放射線診療は今後どう対応すべきか 画像診断を中心に】 臓器特異性MRI造影剤による画像診断へのインパクト 今後の展望も含めて

    吉満 研吾, 中山 智博, 柿原 大輔, 入江 裕之, 田嶋 強, 浅山 良樹, 平川 雅和, 石神 康生, 本田 浩

    日独医報   2005.9

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    【医療環境の変化に対して放射線診療は今後どう対応すべきか 画像診断を中心に】 臓器特異性MRI造影剤による画像診断へのインパクト 今後の展望も含めて

  • 【この処置の直後どう見る?どう動く?】 検査関連 MRIの直後

    石神 康生, 吉満 研吾, 入江 裕之, 田嶋 強, 浅山 良樹, 平川 雅和, 柿原 大輔, 本田 浩

    消化器外科Nursing   2005.9

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    【この処置の直後どう見る?どう動く?】 検査関連 MRIの直後

  • MRIの直後 (特集 この処置の直後 どう見る?どう動く?(1)) -- (検査関連)

    石神 康生, 吉満 研吾, 入江 裕之

    消化器外科nursing   2005.9

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  • 【腎泌尿器疾患のわかりやすい画像診断 正常画像と異常画像】 副腎・後腹膜:後腹膜疾患 後腹膜腫瘍,後腹膜線維症など

    浅山 良樹, 田嶋 強, 吉満 研吾, 入江 裕之, 平川 雅和, 石神 康生, 中山 智博, 柿原 大輔, 本田 浩

    腎と透析   2005.8

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    【腎泌尿器疾患のわかりやすい画像診断 正常画像と異常画像】 副腎・後腹膜:後腹膜疾患 後腹膜腫瘍,後腹膜線維症など

  • 【多臓器疾患の知識 専門医試験に役立つ鑑別診断】 消化管に多発性腫瘍を認める症候群

    宇都宮 尚, 吉満 研吾, 平賀 聖久, 井野 彰浩, 本岡 慎, 赤嶺 珠, 村中 光, 増成 暁, 入江 裕之, 石神 康生, 村山 貞之, 本田 浩

    臨床画像   2005.7

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    【多臓器疾患の知識 専門医試験に役立つ鑑別診断】 消化管に多発性腫瘍を認める症候群

  • 【膵腫瘍の画像診断】 CT

    入江 裕之, 柿原 大輔, 吉満 研吾, 田嶋 強, 浅山 良樹, 平川 雅和, 石神 康生, 中山 智博, 本田 浩

    臨床画像   2005.6

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    【膵腫瘍の画像診断】 CT

  • 【体腔鏡手術に必要な画像診断】 肝・胆嚢・膵

    吉満 研吾, 柿原 大輔, 入江 裕之, 田嶋 強, 浅山 良樹, 平川 雅和, 石神 康生, 中山 智博, 本田 浩, 清水 周次, 武冨 紹信

    臨床放射線   2005.6

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    【体腔鏡手術に必要な画像診断】 肝・胆嚢・膵

  • 【自己免疫性膵炎の新たな展開】 自己免疫性膵炎のCT・MR所見

    入江 裕之, 吉満 研吾, 田嶋 強, 浅山 良樹, 平川 雅和, 石神 康生, 中山 智博, 柿原 大輔, 本田 浩

    肝・胆・膵   2005.4

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    【自己免疫性膵炎の新たな展開】 自己免疫性膵炎のCT・MR所見

  • 【マルチモダリティによるAbdominal Imaging(臨床編) 日常臨床における戦略と選択】 膵腫瘤 膵腫瘤の診断 包括医療時代における膵腫瘤の画像診断 九州大学病院

    入江 裕之, 吉満 研吾, 田嶋 強, 浅山 良樹, 平川 雅和, 石神 康生, 中山 智博, 柿原 大輔, 本田 浩

    INNERVISION   2005.4

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    【マルチモダリティによるAbdominal Imaging(臨床編) 日常臨床における戦略と選択】 膵腫瘤 膵腫瘤の診断 包括医療時代における膵腫瘤の画像診断 九州大学病院

  • 【どう使うマルチスライスCT(MDCT)】 膵癌のMDCT診断 dynamic studyとMPR画像

    入江 裕之, 吉満 研吾, 田嶋 強, 浅山 良樹, 平川 雅和, 石神 康生, 柿原 大輔, 高山 幸久, 本田 浩

    胆と膵   2005.3

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    【どう使うマルチスライスCT(MDCT)】 膵癌のMDCT診断 dynamic studyとMPR画像
    CTは非侵襲的に存在,質的,進展度の総合診断を行えるという点で,膵疾患の画像診断の中心的役割を果たしてきた.さらにMDCTの登場により,時間分解能と空間分解能は飛躍的な進歩をとげ,膵のCT画像も進歩した.高時間分解能は薄いスライス厚での多相性dynamic studyを可能にし,高空間分解能はMPR画像の画質の著明な向上をもたらした.これらのdynamic studyや高分解能MPR画像が膵領域におけるMDCTの最大の利点である.本稿では,膵実質相,門脈相,遅延相の三相撮像を基本とする膵のdynamic studyについて,造影剤の血行動態の観点から解説し,われわれの施設での撮影プロトコールを紹介した.MPR画像およびその発展形ともいえるCPR画像については,その臨床的有用性を強調し,最近のわれわれの試みについても簡単に述べた(著者抄録)

  • 膵胆道系悪性腫瘍の進展度診断における血管解析ソフトの応用

    柿原 大輔, 吉満 研吾, 入江 裕之, 田嶋 強, 浅山 良樹, 平川 雅和, 石神 康生, 中山 智博, 本田 浩

    日本医学放射線学会学術集会抄録集   2005.2

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    膵胆道系悪性腫瘍の進展度診断における血管解析ソフトの応用

  • 【最新の膵癌の診断と治療】 膵癌のMDCTによる術前進展度診断 脈管・膵被膜浸潤などを中心に

    入江 裕之, 吉満 研吾, 田嶋 強, 浅山 良樹, 平川 雅和, 石神 康生, 中山 智博, 柿原 大輔, 本田 浩

    消化器外科   2005.2

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    【最新の膵癌の診断と治療】 膵癌のMDCTによる術前進展度診断 脈管・膵被膜浸潤などを中心に

  • 肋骨の圧排による肝内偽病変と肝機能との関連について

    西江 昭弘, 吉満 研吾, 入江 裕之, 相部 仁, 田嶋 強, 浅山 良樹, 真武 邦茂, 石神 康生, 本田 浩

    日本医学放射線学会雑誌   2004.2

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    肋骨の圧排による肝内偽病変と肝機能との関連について

  • Epidermal growth factor gene expression: Another potential early indicator for late radiation damage of the mouse kidney

    M Otsuka, M Hatakenaka, K Ishigami, K Masuda

    RADIOLOGY   2000.11

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  • 増殖関連遺伝子は晩発性放射線腎障害の早期指標になりうるか

    大塚 誠, 畠中 正光, 石神 康生, 増田 康治

    日本放射線腫瘍学会誌   1999.11

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    増殖関連遺伝子は晩発性放射線腎障害の早期指標になりうるか

  • 腎放射線晩発障害の早期指標としての増殖関連遺伝子

    大塚 誠, 畠中 正光, 石神 康生, 増田 康二

    日本医学放射線学会雑誌   1999.2

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    腎放射線晩発障害の早期指標としての増殖関連遺伝子

  • Magnetization transfer contrast(MTC)に及ぼす筋収縮の影響について

    畠中 正光, 大塚 誠, 石神 康生

    日本医学放射線学会雑誌   1999.2

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    Magnetization transfer contrast(MTC)に及ぼす筋収縮の影響について

  • 術後11年に肝転移をきたした軟骨肉腫の1例

    石神 康生, 花田 清彦, 椎名 丈城

    臨床放射線   1997.9

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    術後11年に肝転移をきたした軟骨肉腫の1例

  • 肝未分化癌(undifferentiated carcinoma of the liver)

    石神 康生, 花田 清彦, 椎名 丈城

    日本医事新報   1997.8

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    肝未分化癌(undifferentiated carcinoma of the liver)

  • 11年後に肝転移をきたした肋骨原発Chondrosarcomaの1例

    石神 康生

    日本医学放射線学会雑誌   1997.4

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    11年後に肝転移をきたした肋骨原発Chondrosarcomaの1例

  • 頭部MR-CT像撮影のroutine化の研究

    藤井 恭一, 花田 清彦, 椎名 丈城, 古屋 暁生, 石神 康生

    断層映像研究会雑誌   1997.3

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    頭部MR-CT像撮影のroutine化の研究

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Industrial property rights

Patent   Number of applications: 2   Number of registrations: 0
Utility model   Number of applications: 0   Number of registrations: 0
Design   Number of applications: 0   Number of registrations: 0
Trademark   Number of applications: 0   Number of registrations: 0

Professional Memberships

  • IVR学会

  • RSNA

  • 日本医学放射線学会

  • 日本腹部放射線学会

  • European Society of Radiology

Committee Memberships

  • 日本腹部放射線学会   Executive   Domestic

    2022.6   

  • 日本医学放射線学会   Executive   Domestic

    2022.4 - 2024.3   

  • 日本医学放射線学会   広報委員会委員長 専門医試験実施委員会委員長   Domestic

    2022.4 - 2024.3   

  • 日本医学放射線学会九州地方会   代表世話人   Domestic

    2020.6 - 2032.3   

  • 日本医学放射線学会   代議員   Domestic

    2016.4 - 2018.4   

  • 日本膵臓学会   嚢胞性膵腫瘍委員会グループ 委員   Domestic

    2016.2 - 2017.3   

  • 日本医学放射線学会   画像診断ガイドライン消化器(膵臓)小委員会委員会委員   Domestic

    2015.3 - 2016.4   

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Academic Activities

  • 教育講演座長

    第59回 日本医学放射線学会 秋季臨床大会  ( Japan ) 2024.9

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  • JCRアワー シンポジスト

    第82回 日本医学放射線学会総会  ( Japan ) 2024.4

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  • 国際交流セッション座長 International contribution

    第82回 日本医学放射線学会総会  ( Japan ) 2024.4

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  • Screening of academic papers

    Role(s): Peer review

    2022

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    Type:Peer review 

    Number of peer-reviewed articles in Japanese journals:2

  • 画像診断

    2021.12 - 2023.12

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    Type:Academic society, research group, etc. 

  • 大会長

    第193回日本医学放射線学会九州地方会  ( Japan ) 2021.6

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  • Screening of academic papers

    Role(s): Peer review

    2021

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    Type:Peer review 

    Number of peer-reviewed articles in foreign language journals:4

  • 腹膜・筋膜に沿った病変の進展 (教育講演) International contribution

    第74回日本医学放射線学会総会  ( Japan ) 2015.4

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    Type:Competition, symposium, etc. 

  • 司会(Moderator)

    第180回日本医学放射線学会 九州地方会  ( Japan ) 2015.2

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    Type:Competition, symposium, etc. 

  • 座長(Chairmanship) International contribution

    Korean Congress of Radiology 2014  ( Coex, Seoul Korea ) 2014.10

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    Type:Competition, symposium, etc. 

  • Diffusion imaging of pancreaticobiliary tumors (教育講演) International contribution

    Korean Congress of Radiology 2014  ( Seoul Korea ) 2014.10

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  • How to improve your English (教育講演) International contribution

    第73回日本医学放射線学会総会  ( Japan ) 2014.4

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  • Imaging of Autoimmune Pancreatitis and IgG4-related disease (教育講演) International contribution

    Iowa Radiological Society  ( Iowa City, IA UnitedStatesofAmerica ) 2013.11

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  • Symposium : Pancreatic Imaging “Cystic lesion” (教育講演) International contribution

    第72回日本医学放射線学会総会  ( Japan ) 2013.4

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    Type:Competition, symposium, etc. 

  • 教育講演5 婦人・泌尿器 2. 腎腫瘤の鑑別診断:嚢胞性腎腫瘤

    第47回日本医学放射線学会秋季臨床大会  ( Japan ) 2011.10

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    Type:Competition, symposium, etc. 

  • 座長(Chairmanship)

    第24回腹部放射線研究会  ( Japan ) 2010.6

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    Type:Competition, symposium, etc. 

  • 教育講演(専門家に学ぶ日常診療)

    日本外科学会総会  ( Japan ) 2009.4

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    Type:Competition, symposium, etc. 

  • MDCT Protocol and Contrast Optimization (教育講演) International contribution

    Iowa Radiological Society  ( Iowa City, IA UnitedStatesofAmerica ) 2003.10

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    Type:Competition, symposium, etc. 

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Research Projects

  • メチオニンPETとAPTイメージングの統合による新たな脳腫瘍診断方法の開発

    Grant number:24K10763  2024.4 - 2027.3

    Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

    楠 正興, 北村 宜之, 三道 幹大, 磯田 拓郎, 栂尾 理, 山田 明史, 石神 康生

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    Grant type:Scientific research funding

    脳腫瘍の特異なアミノ酸代謝を画像化するメチオニンPET(Positron Emission Tomography) は、腫瘍の進展範囲や再発診断などにその有用性が報告されてきた。しかしながら、現時点で主流である静的撮像法(Static Imaging)による術前の腫瘍悪性度の正確な評価は困難とされており、依然発展途上の課題である。本研究では、動的撮像法(Dynamic imaging)により新たな診断パラメータを探索し、これを先進的な分子イメージング技術であるAPT (Amide Proton Transfer)イメージングと統合することで、この課題を克服し悪性度評価の精度向上を目的とする。

    CiNii Research

  • 膵の硬度測定による病態解析の試み

    Grant number:24K10890  2024 - 2026

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Authorship:Principal investigator  Grant type:Scientific research funding

  • 左心補助人工心臓装着に伴う感染症に対するFDG-PET/CTを用いた新たな診断方法の確立

    Grant number:23K07182  2023.4 - 2026.3

    Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

    北村 宜之, 磯田 拓郎, 楠 正興, 三道 幹大, 山田 明史, 馬場 眞吾, 石神 康生

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    Grant type:Scientific research funding

    左室補助人工心臓(LVAD)の装着が必要となっている患者さんにおいて、LVAD装着後の合併症の一つである装着部の感染症があるが、CT検査など従来の画像検査ではその診断が困難である。本研究では、核医学を用いた検査の一つで、すでに国内でも広く利用されているFDG(F-18 Fluorodeoxyglucose)を用いた検査(FDG-PET/CT)をLVAD装着後の患者さんに行い、検査結果を詳しく調べることで、LVAD装着後感染症の診断に有用な画像診断法を確立する。

    CiNii Research

  • 胸部X線動態撮影と人工知能を組み合わせた全自動式肺塞栓症診断システムの開発

    Grant number:23K07111  2023 - 2026

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

  • デジタルトランスフォーメーションを活用した医療従事者の被ばく低減プログラムの開発と有効性の検証

    2022.4 - 2025.3

    Joint research

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    Authorship:Coinvestigator(s)  Grant type:Other funds from industry-academia collaboration

  • APTイメージングを用いた膵臓嚢胞性病変の診断の有用性の確立

    Grant number:22K07641  2022 - 2024

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

  • 深層学習と血管抑制・非抑制画像を利用した新たな転移性脳腫瘍診断法の確立

    Grant number:21K07645  2021 - 2023

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

  • マルチパラメトリックMRIを用いた肝再生の評価・予測モデルの確立

    Grant number:21K07676  2021 - 2023

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

  • 89Zr-PSMA-PETを用いた新たな前立腺癌の画像診断法の確立

    Grant number:21K07622  2021 - 2023

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

  • MRIとテクスチャー解析を応用した腎線維化の低侵襲的定量評価法の開発

    Grant number:19K08124  2020 - 2021

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Authorship:Principal investigator  Grant type:Scientific research funding

  • 診療ガイドラインにおける画像検査の推奨度の決定基準についての研究

    2020 - 2019

    Grants-in-Aid for Scientific Research  Grants-in-Aid for Scientific Research (Ministry of Health, Labour and Welfare)

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    Authorship:Coinvestigator(s)  Grant type:Competitive funding other than Grants-in-Aid for Scientific Research

  • MRIとテクスチャー解析を応用した腎線維化の低侵襲的定量評価法の開発

    Grant number:19K08124  2019 - 2021

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

  • APTイメージングを用いた卵巣嚢胞性病変の早期診断の有用性の確立

    Grant number:18K07683  2018 - 2020

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

  • 診療ガイドラインにおける画像検査の推奨度の決定基準についての研究

    2018

    Grants-in-Aid for Scientific Research  Grants-in-Aid for Scientific Research (Ministry of Health, Labour and Welfare)

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    Authorship:Coinvestigator(s)  Grant type:Competitive funding other than Grants-in-Aid for Scientific Research

  • 大動脈ステント留置後のエンドリークに対する新たな診断法とテーラーメード治療の開発

    Grant number:17K10446  2017 - 2019

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

  • 新たなMR-based pHイメージングの開発とoncologyへの臨床応用

    Grant number:17K10409  2017 - 2019

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

  • 肝細胞機能、肝線維化および肝壊死炎症に対する新たな定量的MRI診断法の開発

    Grant number:17K10407  2017 - 2019

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

  • 幹細胞形質を有する胆道系腫瘍の形態学的特徴および生物学的悪性度の解明

    Grant number:16K10282  2016 - 2018

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

  • 網内系組織イメージング法の開発と応用

    Grant number:24591770  2012 - 2015

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Authorship:Principal investigator  Grant type:Scientific research funding

  • Gd-EOB-DTPA造影MRIを用いた肝細胞癌の抗癌剤耐性の画像的評価法の確立

    Grant number:24591814  2012 - 2014

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

  • 網内系組織イメージング法の開発と応用

    Grant number:24591770  2012

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

  • SPIO-MRIを用いた肝機能・肝線維化の評価法の確立

    Grant number:22591342  2010 - 2012

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

  • 肝幹細胞由来の癌の血管新生および腫瘍間質に関する画像解析

    Grant number:22591343  2010 - 2012

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

  • 高精細融合画像を用いた肝動注化学塞栓療法における術中効果判定システムの開発

    Grant number:22591371  2010 - 2012

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

  • SPIO-MRIで認められる肝細胞癌周囲のT2*短縮行の意義

    Grant number:KJ-19-10  2008

    Grants-in-Aid for Scientific Research  日本医学放射線学会研究助成金

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    Authorship:Principal investigator  Grant type:Competitive funding other than Grants-in-Aid for Scientific Research

  • MR計算画像T2*及びT2mapによる生体肝内鉄の非侵襲的評価とその臨床応用

    Grant number:19591424  2007 - 2009

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant type:Scientific research funding

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Educational Activities

  • 1.クリニカルクラークシップ学生実習:医学部5-6年生を対象とした実習の総括
    2.ベッドサイド学生実習:医学部4-5年生を対象としたベッドサイド実習の総括
    3.学生講義(3年生):総合画像診断の講義
    4.初期、後期研修医の実地指導
    5.専攻医、大学院生、教員の研究、論文作成の指導

Class subject

  • 希少がんを含む各種がんの放射線治療

    2023.10 - 2023.12   Fall quarter

  • 総合画像診断

    2022.10 - 2023.3   Second semester

  • ベッドサイド総括

    2022.10 - 2023.3   Second semester

  • 希少がんを含む各種がんの放射線治療

    2022.10 - 2022.12   Fall quarter

  • ベッドサイド総括

    2022.4 - 2022.9   First semester

  • クリニカルクラークシップ総括

    2022.4 - 2022.9   First semester

  • 希少がんを含む各種がんの放射線治療

    2021.10 - 2021.12   Fall quarter

  • 医学部3年生系統講義:肝・胆・膵  消化管・腹膜

    2015.10 - 2016.3   Second semester

  • 消化管・腹膜

    2015.10 - 2016.3   Second semester

  • 画像診断・各論・腹部II

    2015.4 - 2015.9   First semester

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Visiting, concurrent, or part-time lecturers at other universities, institutions, etc.

  • 2023  神戸大学放射線科  Classification:Part-time lecturer  Domestic/International Classification:Japan 

Outline of Social Contribution and International Cooperation activities

  • ・米国アイオワ大学放射線科で計5年間attendingとして臨床、教育、研究に従事した。
    ・英語論文の査読。
    ・画像診断のコンサルテーション

Social Activities

  • 医学会における英語の役割

    北九州高等専門学校  2014.11

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    Audience:Infants, Schoolchildren, Junior students, High school students

    Type:Seminar, workshop

Media Coverage

  • 「慢性血栓塞栓性肺高血圧症」を早期診断、九州大などの研究班が開発 画像分析で簡便に Newspaper, magazine

    西日本新聞  2023.1

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    「慢性血栓塞栓性肺高血圧症」を早期診断、九州大などの研究班が開発 画像分析で簡便に

Educational Activities for Highly-Specialized Professionals in Other Countries

  • 2022.11   Seoul National University HospitalにてEarly diagnosis of pancreatic cancerというタイトルで特別講義を行った

    Main countries of student/trainee affiliation:Korea, Republic of

  • 2012.7 - 2014.6   Iowa大学放射線科、客員准教授として放射線診断、手技の実地指導を行った。レジデント、フェローに研究テーマを与え、助言と指導を行った。

    Main countries of student/trainee affiliation:United States

  • 2010.3 - 2010.12   Radiology protocol (CT、MRIのプロトコールを紹介する米国の会社)のmedical advisory boardを行っている。

    Main countries of student/trainee affiliation:United States

  • 2001.11 - 2004.11   Iowa大学にてradiology residentの講義、医学生の講義を担当した。CT,MRI、USの読影や消化管・尿路造影の手技と読影、CT・US下生検の実地指導を行った。

    Main countries of student/trainee affiliation:United States

Travel Abroad

  • 2012.7 - 2014.6

    Staying countory name 1:United States   Staying institution name 1:Iowa大学放射線科

  • 2001.11 - 2004.11

    Staying countory name 1:United States   Staying institution name 1:Iowa大学放射線科

Specialized clinical area

  • Biology / Medicine, Dentistry and Pharmacy / Internal Medicine / Radiology

Clinician qualification

  • Specialist

    Japan Radiological Society(JRS)

  • Preceptor

    Japan Radiological Society(JRS)

  • ECFMG certificate

    ECFMG

Year of medical license acquisition

  • 1995