記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   出版者・発行元：European Journal of Radiology  

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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記述言語：英語   出版者・発行元：European Journal of Radiology  

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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記述言語：英語  

DOI： 10.1007/s10334-025-01250-6

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記述言語：英語   出版者・発行元：EJNMMI Reports  

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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記述言語：英語   出版者・発行元：Anticancer Research  

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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記述言語：英語   出版者・発行元：British Journal of Radiology  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Pancreas  

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.

DOI： 10.1097/MPA.0000000000002413

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Surgery (United States)  

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.

DOI： 10.1016/j.surg.2024.108958

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記述言語：英語   出版者・発行元：Neuroradiology  

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/.

DOI： 10.1007/s00234-024-03522-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Neuroradiology  

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.

DOI： 10.1007/s00234-024-03538-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Asian Journal of Endoscopic Surgery  

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.

DOI： 10.1111/ases.70015

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記述言語：英語   出版者・発行元：Physical and Engineering Sciences in Medicine  

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.

DOI： 10.1007/s13246-024-01503-z

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記述言語：英語   出版者・発行元：Dentomaxillofacial Radiology  

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.

DOI： 10.1093/dmfr/twae068

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記述言語：英語  

DOI： 10.2463/mrms.mp.2023-0169

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Journal of Radiology  

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.

DOI： 10.1007/s11604-024-01629-w

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Radiology Open  

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.

DOI： 10.1016/j.ejro.2024.100579

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出版者・発行元：メジカルビュー社  

DOI： 10.18885/ci.0000001871

CiNii Research

出版者・発行元：メジカルビュー社  

DOI： 10.18885/ci.0000001873

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

DOI： 10.2463/mrms.mp.2024-0082

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Radiology Case Reports  

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.

DOI： 10.1016/j.radcr.2024.07.144

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Journal of Radiology  

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.

DOI： 10.1007/s11604-024-01625-0

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出版者・発行元：メジカルビュー社  

DOI： 10.18885/ci.0000001849

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Magnetic Resonance Imaging  

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.

DOI： 10.1016/j.mri.2024.07.011

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出版者・発行元：メジカルビュー社  

DOI： 10.18885/ci.0000001806

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出版者・発行元：学研メディカル秀潤社  

DOI： 10.15105/gz.0000005810

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

DOI： 10.1186/s40792-024-02009-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Heart Journal  

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.

DOI： 10.1536/ihj.24-166

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Neuroradiology  

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.

DOI： 10.1007/s00234-024-03454-4

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出版者・発行元：日本メディカルセンター  

DOI： 10.19020/cg.0000003106

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出版者・発行元：金原出版  

DOI： 10.18888/rp.0000002708

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Thoracic Disease  

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.

DOI： 10.21037/jtd-23-1797

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記述言語：英語   出版者・発行元：Abdominal Radiology  

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.

DOI： 10.1007/s00261-024-04466-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Quantitative Imaging in Medicine and Surgery  

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.

DOI： 10.21037/qims-23-1647

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Radiation Research  

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.

DOI： 10.1093/jrr/rrae052

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記述言語：英語   出版者・発行元：Minimally Invasive Therapy and Allied Technologies  

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.

DOI： 10.1080/13645706.2024.2311720

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記述言語：日本語   出版者・発行元：日本大腸検査学会  

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)

出版者・発行元：メジカルビュー社  

DOI： 10.18885/ci.0000001698

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Abdominal Radiology  

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. Graphical abstract: (Figure presented.)

DOI： 10.1007/s00261-023-04179-3

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記述言語：英語  

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.

DOI： 10.7759/cureus.58376

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

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.

DOI： 10.1038/s41598-024-56210-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Neuroradiology  

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.

DOI： 10.1007/s00234-024-03288-0

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記述言語：英語   出版者・発行元：Diagnostic and Interventional Radiology  

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.

DOI： 10.4274/dir.2023.232381

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出版者・発行元：学研メディカル秀潤社  

DOI： 10.15105/gz.0000005316

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1007/s42399-024-01648-8

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その他リンク： https://link.springer.com/article/10.1007/s42399-024-01648-8/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Neuroradiology  

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.

DOI： 10.1007/s00234-023-03267-x

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記述言語：英語   出版者・発行元：Japanese Journal of Radiology  

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.

DOI： 10.1007/s11604-023-01481-4

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出版者・発行元：金原出版  

DOI： 10.18888/rp.0000002549

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記述言語：英語   出版者・発行元：Medicine (United States)  

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.

DOI： 10.1097/MD.0000000000036417

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Journal of Radiology  

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 (λ HU) 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). λ HU 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 λ HU, they were 0.918 and 0.902 in the portal and delayed phase. Conclusion: dlDECT parameters including NIC and λ HU show promise as indicators for differentiating small-sized GISTs from leiomyomas.

DOI： 10.1007/s11604-023-01473-4

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出版者・発行元：学研メディカル秀潤社  

DOI： 10.15105/gz.0000005005

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

DOI： 10.1002/jmri.29119

記述言語：英語   出版者・発行元：Anticancer Research  

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.

DOI： 10.21873/anticanres.16699

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記述言語：英語   出版者・発行元：Diagnostic and Interventional Radiology  

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.

DOI： 10.4274/dir.2022.221152

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記述言語：英語   出版者・発行元：Neuroradiology  

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

DOI： 10.1007/s00234-023-03228-4

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記述言語：英語   出版者・発行元：Annals of Surgical Oncology  

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.

DOI： 10.1245/s10434-023-13936-z

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出版者・発行元：学研メディカル秀潤社  

DOI： 10.15105/gz.0000004836

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Hepato-Biliary-Pancreatic Sciences  

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.

DOI： 10.1002/jhbp.1345

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Neuroradiology  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

出版者・発行元：メジカルビュー社  

DOI： 10.18885/ci.0000001341

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

出版者・発行元：メジカルビュー社  

DOI： 10.18885/ci.0000001311

CiNii Research

記述言語：英語  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：その他   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.pscychresns.2023.111669

出版者・発行元：金原出版  

DOI： 10.18888/rp.0000002332

CiNii Research

記述言語：その他   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.radi.2023.03.003

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

出版者・発行元：学研メディカル秀潤社  

DOI： 10.15105/gz.0000004455

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   出版者・発行元：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

Web of Science

Scopus

PubMed

記述言語：その他   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

出版者・発行元：金原出版  

DOI： 10.18888/rp.0000002176

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：日本語   出版者・発行元：金原出版(株)  

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。

記述言語：英語   出版者・発行元：Annals of Gastroenterological Surgery  

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.

DOI： 10.1002/ags3.12587

Web of Science

Scopus

PubMed

出版者・発行元：金原出版  

DOI： 10.18888/rp.0000002137

CiNii Research

出版者・発行元：メジカルビュー社  

DOI： 10.18885/ci.0000001064

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：その他   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.mri.2022.05.014

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   出版者・発行元：International Journal of Hematology  

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

Web of Science

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1245/s10434-022-12611-z

出版者・発行元：日本メディカルセンター  

DOI： 10.19020/cg.0000002324

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Supplemental material is available for this article.

DOI： 10.1148/ryct.220086

記述言語：英語   出版者・発行元：Anticancer Research  

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

Web of Science

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   出版者・発行元：European Journal of Radiology  

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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記述言語：英語   出版者・発行元：福岡医学会  

【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（bE00）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bE00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，revisedrainbowそれぞれにおいて，平均嗜好度（a）を求めた． / 【結果】すべての症例において（a）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bE00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bE00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．

DOI： 10.15017/4795999

CiNii Research

出版者・発行元：学研メディカル秀潤社  

DOI： 10.15105/gz.0000002717

CiNii Research

記述言語：英語  

【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)

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：American Journal of Neuroradiology  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/ehjci/jeac027

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   出版者・発行元：Annals of Nuclear Medicine  

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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記述言語：英語   出版者・発行元：European Journal of Radiology Open  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Cancer Diagnosis and Prognosis  

Background/Aim: This study analyzed the parameters provided by preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDGPET/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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記述言語：英語  

DOI： 10.22575/interventionalradiology.2022-0005

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記述言語：英語  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Online supplemental material is available for this article.

DOI： 10.1148/radiol.2021204631

記述言語：英語  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1164/rccm.202102-0387IM

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.mri.2020.08.018

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：その他   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.rpor.2020.05.001

記述言語：その他   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.rpor.2020.05.001

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/eurheartj/ehaa443

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：その他  

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

DOI： 10.1111/1754-9485.12961

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.1177/0284185119872687

記述言語：その他  

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

DOI： 10.1111/srt.12775

記述言語：その他  

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

DOI： 10.1016/j.radcr.2019.06.027

記述言語：英語  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：その他  

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

DOI： 10.1007/s13244-014-0373-x

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：日本語  

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

DOI： 10.15017/1477814

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：その他  

Radiologic manifestations of angioedema.

DOI： 10.1007/s13244-014-0329-1

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/jmri.22411

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：その他  

[Recent progress of diagnostic imaging in evaluating pancreaticobiliary malignancies].

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：日本語  

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．

DOI： 10.11405/nisshoshi.103.1333

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語  

DOI： 10.1007/s00330-006-0167-8

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2214/ajr.183.6.01831708

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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