担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To retrospectively evaluate the depiction rate of feeding arteries in biopsy-proven clear cell renal cell carcinoma (CCRCC) on four-dimensional computed tomography angiography (4D-CTA) images. MATERIALS AND METHODS: This study included 22 patients with 22 CCRCC and 30 feeding arteries treated with transcatheter renal artery embolization. The depiction rate of the feeding arteries on preprocedural 4D-CTA was evaluated. Images were acquired by 320-row multi-detector computed tomography (CT) 15‒36 s after starting to inject a contrast agent (600 mg/kg iodine) intravenously into patients at 2.1 s intervals (11 phases). Two board-certified radiologists retrospectively assessed the feeder depiction rate in all 11 phases with reference to the procedural images as the gold standard. Discrepancies were resolved by consultation with a third radiologist. RESULTS: Among the feeders, 11 (36.7%) were segmental or lobar, and 19 (63.3%) were interlobar or arcuate arteries. The feeder depiction rate was the highest (25 [83.3%] of 30) in the 5th phase (delay, 23.4 s) where the gap in contrast enhancement between the renal artery and cortex was the largest. This was followed by the 6th (23 [76.7%] of 30), 4th (22 [73.3%] of 30]), and 7th (21 [70.0%] of 30) phases. The overall rate of depicting feeding arteries in the 11 phases of 4D-CTA was 28 (93.3%) of 30. CONCLUSIONS: The depiction rate of CCRCC feeding arteries including lobar or smaller artery branches by 4D-CTA was favorable. The feeding arteries were optimally visualized during the phase with the largest contrast gap between the renal artery and cortex.

DOI： 10.1007/s11604-024-01538-y

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担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

This retrospective study investigated whether necrotic lesions detected on a computed tomography (CT) scan are more regressive than non-necrotic lesions after methotrexate withdrawal in patients pathologically diagnosed with methotrexate-associated lymphoproliferative disorders (MTX-LPD). In total, 89 lesions extracted from 24 patients on CT scans were included in the analysis. All patients had been evaluated for the presence of necrosis within lesions via CT scan upon first suspicion of MTX-LPD (baseline CT scan). The percentage lesion size reduction between the baseline and initial follow-up CT scan was calculated. The association between necrosis within lesions and size changes was estimated via linear regression analyses using both crude and adjusted models. Necrosis was significantly more common in extranodal lesions (27 out of 30 lesions, 90%) than in nodal lesions (9 out of 59 lesions, 15%, p<0.001). In the crude model, the regression of necrotic lesions was 58.5% greater than that of non-necrotic lesions; the difference was statistically significant (p<0.001). Additionally, the longest diameter of necrotic lesions at the baseline CT scan was significantly greater than that of non-necrotic lesions (p<0.001). Based on the adjusted model, necrotic lesions showed 49.3% greater regression than non-necrotic lesions (p=0.017). Necrosis detected on a CT scan was found to be an independent predictor of regression after MTX withdrawal in patients with MTX-LPD.

DOI： 10.18926/AMO/66668

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担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Purpose

To retrospectively assess the time course of complications after image-guided small renal mass biopsy using initial follow-up imaging.

Materials and methods

A total of 190 masses (mean, 2.1 ± 0.70 cm; range, 0.6–3.8 cm) were assessed using initial computed tomography (43 non-enhanced and 141 enhanced) or magnetic resonance imaging (five non-enhanced and one enhanced) after biopsy. Initial follow-up imaging was classified into two groups (i.e., with or without hematoma) and various factors were compared.

Results

The masses were histologically diagnosed in all patients except one. Post-procedural complications included 129 Grade I hematomas, 1 Grade I hemothorax, 9 Grade II hematomas, and 1 Grade IIIa pneumothorax. Residual 28 Grade I and 6 Grade II hematomas and 8 new complications (6 small hematomas, 1 pseudoaneurysm, and 1 arteriovenous fistula) were observed on the initial follow-up imaging obtained at a median of 21 days (3–90 days) after the biopsy. On the initial follow-up imaging, the groups with and without hematoma differed significantly in the following factors: age (P = 0.04), size (P = 0.02), guided images (P &lt; 0.01), hematoma at the end of the procedure (P &lt; 0.01), and days after biopsy (P &lt; 0.01). Although three masses exhibited &gt; 25% shrinkage, no significant change was observed in mass diameter on initial follow-up imaging (mean, 2.1 ± 0.71 cm; P = 0.90).

Conclusion

Initial follow-up imaging after a biopsy revealed improvements in most of the complications, a few new complications, and an unchanged mass diameter.

DOI： 10.1007/s11604-023-01509-9

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その他リンク： https://link.springer.com/article/10.1007/s11604-023-01509-9/fulltext.html

担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: This single-center, single-arm, prospective, open-label study was conducted to evaluate the optimal number of cores (single or multiple) in renal tumor biopsy. MATERIALS AND METHODS: Forty-four biopsies of 44 tumors (mean diameter, 2.7 ± 1.0 cm; range, 1.6-5.0 cm) were included. Biopsy was performed under ultrasound or computed tomography fluoroscopy guidance using an 18-gauge cutting needle and the co-axial method. Two or more specimens were obtained, which were divided into first and subsequent specimens. "First specimen" and "all specimens" were histologically evaluated (i.e., appropriateness of specimen, histological diagnosis, subtype, and Fuhrman grade of renal cell carcinoma [RCC]) blindly and independently by two board-certified pathologists. RESULTS: Multiple specimens were successfully and safely obtained in all the biopsies. All tumors were histologically diagnosed; 40 malignancies included 39 RCCs and 1 solitary fibrous tumor, and 4 benign lesions included 2 angiomyolipomas, 1 oncocytoma, and 1 capillary hemangioma. In all RCCs, the subtype could be determined (32 clear cell RCCs, 4 chromophobe RCCs, and 3 papillary RCCs), and the Furman grade was determined in 38 RCCs. When only the first specimen was evaluated, 22.7% of the specimens were inappropriate for diagnosis, and 34 (77.3%) were histologically diagnosed. The diagnostic yield was significantly lower than that of all specimens (P = 0.0044). Univariate analysis revealed that smaller lesions were a significant predictor of diagnostic failure (P = 0.020). CONCLUSION: Biopsy with multiple cores significantly improved diagnostic yield. Thus, operators should obtain multiple cores during renal tumor biopsy.

DOI： 10.1007/s11604-023-01496-x

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担当区分：最終著者  

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担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Background

Surgical resection of esophageal cancer is frequently performed to achieve a complete cure. However, the postoperative recurrence rate is 36.8–42.5%, leading to poor prognosis. Radiation therapy has been used to treat recurrences; solitary recurrence has been proposed as a prognostic factor for radiation therapy, though its significance is unclear. ¹⁸F-fluorodeoxyglucose positron emission tomography is a highly accurate diagnostic modality for esophageal cancer. This retrospective study aimed to analyze the outcomes of solitary postoperative recurrences of esophageal squamous cell carcinoma diagnosed with ¹⁸F-fluorodeoxyglucose positron emission tomography and treated with definitive radiation therapy.

Methods

We examined 27 patients who underwent definitive radiation therapy for single or multiple postoperative recurrences of esophageal squamous cell carcinoma between May 2015 and April 2021. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography was performed within 3 months before the commencement of radiation therapy. Kaplan–Meier, univariate, and multivariate analyses were performed to examine the overall survival and identify potential prognostic factors.

Results

The 1-, 2-, and 3-year overall survival rates were 85.2%, 62.6%, and 47.3%, respectively, and solitary recurrence was the only significant factor associated with overall survival (P = 0.003). The 1-, 2-, and 3-year overall survival rates in patients with solitary recurrence were 91.7%, 80.2%, and 80.2%, respectively, and in patients with multiple recurrences they were 80.0%, 50.3%, and 25.1%, respectively. Multivariate analysis also showed solitary recurrence as a significant factor for overall survival.

Conclusions

When diagnosed with ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography, solitary recurrence appears to have a more favorable prognosis than multiple recurrences.

DOI： 10.1007/s10388-023-01000-4

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その他リンク： https://link.springer.com/article/10.1007/s10388-023-01000-4/fulltext.html

担当区分：最終著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Purpose

To retrospectively evaluate cryoablation combined with prior transcatheter arterial embolization (TAE) for renal cell carcinoma (RCC) in non-dialysis patients with stage 4 or 5 chronic kidney disease (CKD).

Materials and methods

Patients with stage 4 or 5 CKD undergoing TAE and cryoablation for RCC between May 2012 and October 2021 were included. TAE was selectively performed using iodized oil with absolute ethanol or gelatin sponge 1–14 days before cryoablation. Local efficacy, safety, and changes in renal function were evaluated.

Results

Nine patients (seven men and two women; median age, 64 years; range 52–88 years) with nine RCCs (mean diameter, 3.0 ± 1.0 cm; range 1.7–4.7 cm) were included. The mean pre-treatment estimated glomerular filtration rate (eGFR) was 24.2 ± 5.6 ml/min/1.73 m² (range 10.4–29.2 ml/min/1.73 m²). The mean amount of contrast medium used in TAE was 58 ± 29 ml (range 40–128 ml). Except in one patient (grade 3 pyelonephritis), no grade ≥ 3 complications occurred. During the follow-up period (median, 18 months; range 7–54 months), no local tumor progression occurred. In two patients with pre-treatment eGFR of &lt; 20 ml/min/1.73 m², hemodialysis was initiated at 3 and 19 months after cryoablation. At their last follow-up, the remaining seven patients showed a decrease of 6.2 ± 5.3 ml/min/1.73 m² (range 0.7–17.2 ml/min/1.73 m²) in their eGFR.

Conclusion

Cryoablation combined with TAE for RCC in non-dialysis patients with stage 4 or 5 CKD was effective and safe, with an acceptable impact on renal function.

DOI： 10.1007/s11604-023-01416-z

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その他リンク： https://link.springer.com/article/10.1007/s11604-023-01416-z/fulltext.html

記述言語：英語  

We report a rare case of idiopathic spinal cord herniation (ISCH) with a history of cerebrospinal fluid (CSF) leakage. ISCH is a protrusion of the spinal cord through a dural defect. Thin constructive interference in steady-state (CISS) images clearly demonstrated the herniated cord in the present case. The myelopathy worsened and the patient underwent surgery for reduction of herniated spinal cord; the dural defect was filled by placing collagen matrix graft (DuraGen®) between the inner and outer dural layers. The patient's symptoms have improved without relapse for 8 months since surgery. This method may be a good surgical option for cases of spinal cord herniation.

DOI： 10.18926/AMO/64124

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担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Purpose

To retrospectively assess the feasibility, safety, renal function, technique efficacy rate, and survival of patients with clinical T3a renal cell carcinoma (RCC).

Materials and methods

Sixteen cryoablation sessions were performed in 14 patients (10 men; mean age, 69.8 ± 10.5 years; range, 49–90 years) with 14 clear cell T3a RCCs (mean, 3.3 ± 0.9 cm; range, 1.9–5.2 cm). One patient was on dialysis. Transcatheter arterial embolization was performed before cryoablation in 15 sessions. The primary endpoint was the technique efficacy rate. The secondary endpoints included feasibility, safety, renal function, and survival.

Results

Cryoablation was technically successful in all RCC cases. In two RCCs, cryoablation was performed twice because of local tumor progression. No major adverse events were observed. All patients were alive without metastases, with a median follow-up of 45 months (6−93 months). Complete response was achieved by cryoablation in 11 RCCs (78.6%). The primary and secondary technique efficacy rates were 77.1% and 84.4% at 1 year, 57.9% and 73.9% at 3 years, and 57.9% and 73.9% at 5 years, respectively. One patient underwent dialysis given a total contralateral nephrectomy due to another RCC 1 month after initial cryoablation and a total ipsilateral nephrectomy 46 months after initial cryoablation due to local progression. Except for two dialysis patients, of the 12 patients with a median follow-up of 41 months (6–93 months), none were on dialysis.

Conclusion

Cryoablation was safe and effective in T3a RCC, which mainly involved the renal venous branches and may represent an alternative treatment for inoperable patients.

DOI： 10.1007/s11604-022-01297-8

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その他リンク： https://link.springer.com/article/10.1007/s11604-022-01297-8/fulltext.html

担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Purpose

This review aimed to summarize the treatment outcomes of percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) for metastatic liver tumors based on the findings of published studies over the last decade.

Materials and methods

Literature describing the survival outcomes of ablation therapy for liver metastases was explored using the PubMed database on April 26, 2022, and articles published in 2012 or later were selected. The included studies met the following criteria: (i) English literature, (ii) original clinical studies, and (iii) literature describing overall survival (OS) of thermal ablation for metastatic liver tumors. All case reports and cohort studies with fewer than 20 patients and those that evaluated ablation for palliative purposes were excluded.

Results

RFA was the most commonly used method for ablation, while MWA was used in several recent studies. RFA and MWA for liver metastases from various primary tumors have been reported; however, majority of the studies focused on colorectal cancer. The local control rate by RFA and MWA varied widely among the studies, ranging approximately 50–90%. Five-year survival rates of 20–60% have been reported following ablation for colorectal liver metastases by a number of studies, and several reports of 10-year survival rates were also noted.

Conclusion

Comparative studies of local therapies for colorectal liver metastases demonstrated that RFA provides comparable survival outcomes to surgical metastasectomy and stereotactic body radiation therapy.

DOI： 10.1007/s11604-022-01335-5

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その他リンク： https://link.springer.com/article/10.1007/s11604-022-01335-5/fulltext.html

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

Abstract

Purpose

To retrospectively evaluate and correlate the contrast-enhanced computed tomography (CECT) and non-enhanced magnetic resonance imaging (MRI) during the early period following renal cryoablation.

Materials and methods

Both dynamic CECT and non-enhanced MRI were performed within 4 days following cryoablation in 34 renal tumors in 33 patients. The renal volumes of the unenhanced regions on dynamic CECT (nephrogenic phase, 4 mm thickness) and the regions with signal intensity changes on non-enhanced MRI (fat-suppressed T2-weighted image, 4 mm thickness) were evaluated. Fusion images of the axial, coronal, and sagittal sections of CECT and MRI images were created from the maximum cross-section of the renal tumor, and the match score of each image was visually evaluated on a 5-point scale.

Results

The mean renal volume of the unenhanced regions on CECT and those with signal intensity changes on non-enhanced MRI following cryoablation were 29.5 ± 19.9 cm³ (range, 4.3–97.4 cm³) and 30.7 ± 19.8 cm³ (range, 6.7–94.0 cm³), respectively; the difference between them was –1.17 cm³ (95% confidence interval [CI] –2.74, 0.40, P = 0.139). The Pearson’s product-moment correlation coefficient (r = 0.975; 95% CI, 0.951, 0.988; P &lt; 0.0001) showed a strong correlation between the volumes. The average match score between CECT and non-enhanced MRI was as high as 4.5 ± 0.5 points (radiologist 1, 4.3 ± 0.5; radiologist 2, 4.7 ± 0.5). Local tumor control rate was 94.1% (32/34 tumors) and recurrence-free survival rate was 82.0% (95% CI: 64.2%, 91.5%) at 5 years.

Conclusions

The region with signal intensity changes on non-enhanced MRI was strongly correlated with the unenhanced region on CECT during the early period following renal cryoablation.

DOI： 10.1007/s11604-022-01285-y

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その他リンク： https://link.springer.com/article/10.1007/s11604-022-01285-y/fulltext.html

担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

The aim of this review was to summarize the latest evidence on image-guided thermal ablation therapies for lung metastases. PubMed was used to search for relevant articles that reported the oncological outcomes of thermal ablation for metastatic lung tumors, and those published in 2010 or later were selected for review. Ablative therapies were applied for lung metastases from various types of primary tumors, but most commonly colorectal ones. Radiofrequency ablation (RFA) was the most evaluated technique, followed by microwave ablation (MWA). The local control rates of ablative therapies were generally favorable, approximately 80–90% in many studies. Representative studies demonstrated promising overall survival rates of approximately 50% or higher 5 years after ablation for lung metastases from colorectal cancer or mixed types of primary tumors. Nevertheless, the survival outcomes varied depending on the type of primary tumor and background factors of patients such as other metastases and comorbidities. Several studies had aimed to compare the outcomes of various ablative therapies such as RFA, MWA, and cryoablation; however, conclusive data are not yet available to determine the most appropriate ablation modality for lung metastases. Further data accumulation is needed, especially for long-term outcomes and comparisons with other therapies.

DOI： 10.1007/s11604-022-01302-0

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その他リンク： https://link.springer.com/article/10.1007/s11604-022-01302-0/fulltext.html

担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

PURPOSE: The purpose of this study was to retrospectively determine the incidence of early enlarging cavitation after percutaneous radiofrequency ablation (RFA) of lung tumor and identify risk factors associated with their occurrence. PATIENTS AND METHODS: A total of 245 patients (140 men, 105 women; mean age, 62.7 ± 11.8 [SD] years; age range: 31-87 years) with 605 lung tumors who were treated using 401 RFA sessions from April 2010 to March 2020 were included. Of which, 31 patients with 38 early enlarging cavitation and control group (151 patients with 228 tumors) were analyzed. Early enlarging cavitation was defined as cavities with an enlarged size (>3 cm) occurring on ablated lesions within seven days after RFA. Incidence of cavitation, risk and post-procedural factors of occurrence, major adverse events (AEs) that occurred in RFA sessions with cavitation, and course of cavitation were evaluated. AEs were classified using the CIRSE classification system for complications. RESULTS: Thirty-eight cavities (6.3%, 38/605 tumors) in 31 patients occurred in an average of 3.1 ± 1.7 days (range, 1-7 days) after 32 RFA sessions. Distance from pleura ≥ 20 mm, contact with vessel ≥ 3 mm, multitined expandable electrode ≥ 3 cm, and bronchus ≥ 2 mm encompassed in the ablation zone were independent risk factors of occurrence. Fever ≥ 38.5 °C, white blood cell count ≥ 10,000/μl one day after RFA, and steroid therapy were independent post-procedural factors of occurrence. Twenty-four Grade 3 and two Grade 6 AEs occurred. Twenty-nine cavities disappeared within a mean duration of 111.9 ± 64.9 (SD) days (range: 44-274 days) and four remained with a mean follow-up of 279.2 ± 174 (SD) days; five patients were lost to follow-up. CONCLUSIONS: Early enlarging cavitation occurs in 6.3% of lung tumors treated with RFA and are associated with 26 major AEs in 32 sessions. Aforementioned procedural factors and post-procedural inflammation were significant risk factors of occurrence.

DOI： 10.1016/j.diii.2022.05.004

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担当区分：最終著者   記述言語：英語   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/s10147-022-02224-7

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その他リンク： https://link.springer.com/article/10.1007/s10147-022-02224-7/fulltext.html

担当区分：最終著者   記述言語：日本語   出版者・発行元：金原出版(株)  

症例は40歳代女性で、検診目的に産婦人科を受診し、子宮腫瘍を指摘されたため、精査加療目的に当院紹介となった。MRIではT1強調像で均一な低信号、T2強調像で均一な中間的高信号、拡散強調像で高信号、ADCの低下を認めた。MRI上、低異型度子宮内膜間質肉腫(low-grade ESS)を疑ったが、当院受診2ヵ月前に全身検索目的で撮像された18F-FDG-PET/CTにて腫瘤に異常高集積を認めなかったため、静脈内平滑筋腫症を否定できなかった。肉腫の可能性を考慮して開腹子宮全摘術、両側付属器切除術を施行した。病理所見では、細胞質の乏しい短紡錘形細胞の増殖がみられ、螺旋動脈様の小血管が規則的に介在しており、部分的に筋層に分け入るような浸潤像も認められ、low-grade ESSに特徴的な所見であった。

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担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press (OUP)  

Abstract

We analyzed the local control (LC) of cervical squamous cell carcinoma treated by computed tomography (CT)-based image-guided brachytherapy (IGBT) using central shielding (CS). We also examined the value of tumor diameter before brachytherapy (BT) as a factor of LC. In total, 97 patients were analyzed between April 2016 and March 2020. Whole-pelvic (WP) radiotherapy (RT) with CS was performed, and the total pelvic sidewall dose was 50 or 50.4 Gy; IGBT was delivered in 3–4 fractions. The total dose was calculated as the biologically equivalent dose in 2 Gy fractions, and distribution was modified manually by graphical optimization. The median follow-up period was 31.8 months (6.3–63.2 months). The 1- and 2-year LC rates were 89% and 87%, respectively. The hazard ratio was 10.11 (95% confidence interval: 1.48–68.99) for local recurrence in those with a horizontal tumor diameter ≥ 4 cm compared to those with &amp;lt; 4 cm before BT. In CT-based IGBT for squamous cell carcinoma, favorable LC can be obtained in patients with a tumor diameter &amp;lt; 4 cm before BT. However, if the tumor diameter is ≥ 4 cm, different treatment strategies such as employing interstitial-BT for dose escalation may be necessary.

DOI： 10.1093/jrr/rrac040

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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：Elsevier BV  

DOI： 10.1016/j.amjmed.2022.02.042

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担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.diii.2022.01.008

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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：Hindawi Limited  

Herein, we report two cases of duodenal ulcers that developed after transcatheter procedures for the treatment of unruptured artery aneurysms. Both patients recovered after the administration of nothing by mouth, intravenous fluids, and proton-pump inhibitors. Notably, the duodenal ulcer was unchanged in one patient six days after endovascular treatment and improved in the other patient 13 days after angiography. These cases suggest that conservative treatment is acceptable in patients with duodenal ischemia that develops as an adverse effect of endovascular procedures. The usefulness of esophagogastroduodenoscopy in such patients has also been highlighted.

DOI： 10.1155/2022/9988216

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その他リンク： http://downloads.hindawi.com/journals/crigm/2022/9988216.xml

担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.diii.2021.11.003

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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：SAGE Publications  

Background

Meningiomas are occasionally fed by pial blood supply (PBS). It is postulated that peritumoral flow void (PTFV), peritumoral brain edema (PTBE), and absence of an arachnoid plane (AP) are useful parameters for evaluating PBS.

Purpose

To determine whether conventional magnetic resonance imaging (MRI) using a multiparametric scoring system (MSS) is a useful way to predict PBS.

Material and Methods

Forty-six patients were included and divided: PBS and non-PBS groups. Differences between the groups in six parameters of MR imaging were analyzed: tumor size, tumor location, PTBE grade, AP grade, PTFV, and MIB1 labeling index (MIB1-LI) grade. Cutoff values were determined using receiver operating characteristic (ROC) curve analysis for the differentiation of both groups based on statistically significant parameters. All cases were scored as 1 (PBS) or 0 (non-PBS) for each parameter according to set thresholds. Individual scores were totaled for each case, yielding a combined score for each case to obtain a cutoff value using ROC curve analysis for the MSS.

Results

Peritumoral brain edema grade, AP grade, PTFV, and MIB-LI grade were statistically associated with PBS. Receiver operating characteristic curve analyses showed that PTBE grade 3 or 4, AP grade 3 or 4, and PTFV positivity had the highest accuracy of 69%, 64%, and 68%, respectively. Regarding the MSS, a cutoff value of 2 had the highest accuracy of 71%; PBS diagnosis was indicated by at least two of the three parameters, namely, PTBE grade, AP grade, and PTFV.

Conclusion

The MSS is a useful way to predict PBS in intracranial meningiomas on MRI.

DOI： 10.1177/20584601221091208

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その他リンク： http://journals.sagepub.com/doi/full-xml/10.1177/20584601221091208

記述言語：英語   掲載種別：研究論文（学術雑誌）  

To evaluate the volume and heat-sink effects of microwave ablation (MWA) in the ablation zone of the normal swine lung. MWA at 100 W was performed for 1, 2, and 3 min in 7, 5, and 5 lung zones, respectively. We assessed the histopathology in the ablation zones and other outcome measures: namely, length of the longest long and short axes, sphericity, ellipsoid area, and ellipsoid volume. The mean long- and short-axis diameters were 22.0 and 14.1 mm in the 1-min ablation zone, 27.6 and 20.2 mm in the 2-min ablation zone; and 29.2 and 21.2 mm in the 3-min ablation zone, respectively. All measures, except sphericity, were significantly less with 1-min ablation than with either 2- or 3-min ablation. There were no significant differences between the 2- and 3-min ablation zones, but all measures except sphericity were larger with 3-min ablation. Although there were no blood vessels that resulted in a heat-sink effect within the ablation zones, the presence of bronchi nearby in 5 lung ablation zones resulted in reduced ablation size. In high-power, short-duration MWA, the lung ablation volume was affected by ablation time. Some ablations showed that a heat-sink effect by a neighboring bronchus might occur.

DOI： 10.18926/AMO/63212

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We intended to investigate whether muscle and adipose masses were associated with prognosis among patients with stage III non-small-cell lung cancer (NSCLC) who were undergoing chemoradiotherapy (CCRT). We retrospectively explored data of patients with stage III NSCLC who underwent definitive CCRT (≥ 60 Gy) between January 2004 and March 2018 at our hospital. We examined the relationship of overall survival (OS) with body mass index (BMI), skeletal muscle index (SMI), psoas muscle index (PMI), visceral adipose tissue index (VAI), subcutaneous adipose tissue index (SAI), and visceral-to-subcutaneous adipose tissue area ratio (VSR) using log-rank tests for the univariate analysis and Cox proportional hazard models for the multivariate analysis. Overall, 16, 32, and 12 patients had stage IIIA, IIIB, and IIIC NSCLC, respectively. The total radiotherapy dose ranged from 60 Gy/30 fractions to 66 Gy/33 fractions. In the univariate analysis, the performance status (PS), BMI, and SMI were associated with OS, whereas the PMI, VAI, SAI, and VSR were not. In the multivariate analysis, the PS and SMI were associated with OS. The hazard ratios and 95% confidence intervals were 2.91 and 1.28–6.64 for PS, and 2.36 and 1.15–4.85 for SMI, respectively. The 1, 3, and 5-year OS rates were 92.1%, 59.6%, and 51.0% in patients with high SMI, and 63.6%, 53.8%, and 17.9% in patients with low SMI, respectively. The SMI correlated with prognosis in our study population, whereas adipose mass did not. Therefore, sarcopenia should be considered while predicting the OS in such patients.

DOI： 10.1038/s41598-021-91449-z

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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：Elsevier BV  

DOI： 10.1016/j.jvir.2021.12.003

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担当区分：最終著者  

DOI： 10.18999/nagjms.84.4.746

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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/s11604-021-01211-8

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その他リンク： https://link.springer.com/article/10.1007/s11604-021-01211-8/fulltext.html

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

Purpose: We summarized the findings, diagnosis, and outcomes of cases for which contrast examination of central venous access ports (CV-ports) were attempted to detect complications. Materials and methods: Fifty-seven contrast examinations were attempted for 45 patients with 46 CV-ports (median, 162 days after implantation). Contrast examination was performed due to three suspicion catheter fractures or 54 CV-port dysfunctions (combinations of an absence of blood reflux on aspiration and 9 sufficient, 21 insufficient, or 24 impossible drip infusions). Results: Contrast examination was successfully performed in 52 cases and revealed 45 normal findings, 5 pericatheter fibrin sheath formations, and 2 partial catheter fractures. In 23 of 45 cases with normal findings, the resistance to injection was initially mild or moderate but resolved after the CV-port was flushed slowly with heparinized saline solution. Subsequent contrast examination demonstrated normal findings. All fibrin sheath formations disappeared after thrombolytic therapy. Five cases could not undergo contrast examination due to high resistance. After contrast examination, nine of 46 CV-ports were removed or exchanged, while the use of the remaining 37 continued. Conclusion: Contrast examination of CV-port allowed the assessment of suspected complications and early treatment.

DOI： 10.1007/s11604-021-01142-4

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記述言語：日本語   出版者・発行元：(一社)日本小児整形外科学会  

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担当区分：最終著者   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/s00270-021-02995-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Pulmonary lymphatic involvement of sarcomas is an extremely rare form of metastases. We report the computed tomography (CT) features of pathologically confirmed pulmonary lymphatic involvement from metastatic uterine sarcomas. The CT illustrated smooth or nodular thickenings of the interlobular septa and bronchovascular bundle. Moreover, ground-glass opacity along the interlobular septa was also detected. These findings suggest that lymphatic involvement has diagnostic value for detecting this rare form of metastatic sarcomas. We also discuss possible differential diagnoses in this case and review previous cases reporting pulmonary lymphatic involvement in metastatic sarcomas. To the best of our knowledge, this is the first report describing pulmonary lymphatic involvement in metastatic uterine sarcomas. Pulmonary lymphatic spread of sarcomas is a rare form of metastatic sarcomas, but it should be considered when these findings suggesting lymphatic involvement are detected on CT.

DOI： 10.1016/j.radcr.2021.05.076

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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 retrospectively compare two puncture routes (transpleural vs. transpulmonary) for computed tomography (CT) fluoroscopy-guided cutting needle biopsy of lung nodules with pleural contact. Patients and methods: A total of 102 patients (72 men; mean age, 71.1 ± 9.5 [SD] years) were included and 102 biopsies of 102 lung nodules (mean size, 16.7 ± 5.9 [SD] mm; range, 6.0–29.4 mm; mean length of pleural contact, 10.1 ± 4.2 [SD] mm; range, 2.8–19.6 mm) were analyzed. All procedures were classified as biopsies via the direct transpleural route or the transpulmonary route. The patient-, lesion-, and biopsy-related variables, diagnostic yields, and incidence of complications were compared between the two routes. Results: Biopsy was performed via the direct transpleural route (n = 59; 57.8%) and transpulmonary route (n = 43; 42.2%). In the transpulmonary route group, the mean distance of the intrapulmonary pathway was 17.7 ± 9.4 [SD] mm (range: 4.1–47.6 mm; P < 0.001) and the introducer needle trajectory angle of < 45° was significantly observed (8.5% [5/59] vs. 60.5% [26/43]; P < 0.001). There was no significant difference in diagnostic accuracy between the direct transpleural and transpulmonary routes (93.2% [55/59] vs. 90.7% [39/43]; P = 0.718). The frequencies of all complications (64.4% [38/59] vs. 97.7% [42/43]; P < 0.001), pneumothorax (33.9% [20/59] vs. 65.1% [28/43]; P = 0.003), pneumothorax with chest tube placement (3.4% [2/59] vs. 18.6% [8/43]; P = 0.016), and pulmonary hemorrhage (47.5% [28/59] vs. 76.7% [33/43]; P = 0.004) were significantly lower in the direct transpleural group. Conclusion: Direct transpleural route is recommended for CT fluoroscopy-guided biopsy of lung nodules with pleural contact because it is safer and yields similar diagnostic accuracy than transpulmonary route.

DOI： 10.1016/j.diii.2021.05.005

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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：SPRINGER  

Purpose: To retrospectively evaluate long-term efficacy of percutaneous cryoablation for lower limb soft-tissue venous malformations. Materials and Methods: Nine patients (mean age, 36.6 years) with lower limb soft-tissue venous malformations were included. Cryoablation was performed percutaneously using an argon-based system. Adverse events (AE) using the Common Terminology Criteria for AEs version 4.0 were evaluated. The visual analog scale (VAS) scores and lesion volumes measured on magnetic resonance imaging were also evaluated at 12 months and 5–6 years. Results: Technical success (i.e., complete coverage of the lesion by an iceball) was achieved in eight of the nine patients. All patients developed a total of 14 grade 1 or 2 adverse events. The mean (± standard deviation) VAS score was 6.0 (± 1.7) before therapy, whereas it was 0.14 (± 0.27) at 12 months and 0.97 (± 1.3) at 5–6 years (58–78 months). Complete pain relief was obtained in 6 and 5 patients at 12 months and 5–6 years, respectively. The median lesion volume was 2.49 mL before therapy, whereas it was 0.26 mL at 12 months and 0.35 mL at 5–6 years. Conclusion: Percutaneous cryoablation of lower limb soft-tissue venous malformations achieved considerable pain relief and lesion shrinkage for 5–6 years in this small preliminary study. Level of Evidence: Level 4, Case Series.

DOI： 10.1007/s00270-021-02876-4

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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：Wiley  

DOI： 10.1111/nep.13966

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/nep.13966

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

Background: The association between sarcopenia and prognosis in patients with locally advanced non-small cell lung cancer (NSCLC) undergoing trimodality therapy, consisting of preoperative concurrent chemoradiotherapy and surgery, has not been reported. Therefore, we aimed to investigate the association of sarcopenia and fat mass with prognosis after trimodality therapy. Methods: To assess sarcopenia, the psoas muscle mass was measured. Using computed tomography data, including third lumbar vertebra level images, psoas muscle mass and visceral and subcutaneous fat mass were measured. Additionally, body mass indices, and visceral/subcutaneous fat ratio, obtained by dividing the visceral fat index by the subcutaneous fat index, were calculated. We investigated the relationship between these parameters and overall survival. Results: Ninety-nine eligible patients were included. In the univariate analysis, age, clinical stage, tumor location, psoas muscle index, and visceral/subcutaneous fat ratio were significant prognostic factors for overall survival (P = 0.008, P = 0.04, P = 0.04, P = 0.02, and P = 0.02, respectively). In the multivariate analysis, age and psoas muscle index were significant prognostic factors for overall survival (P = 0.01 and P = 0.03, respectively). The 5-year overall survival rates for the high and low psoas muscle index groups were 79.6% [95% confidence interval (CI), 67.1–94.5%] and 66.2% (95% CI, 54.1–81.1%), respectively; whereas, the 10-year overall survival rates were 61.9% (95% CI, 42.0–91.4%) and 25.3% (95% CI, 8.6–74.2%), respectively. Conclusion: Sarcopenia was related to poor overall survival in patients with locally advanced NSCLC undergoing trimodality therapy. Assessment of body composition prior to treatment may provide important information for formulating rational therapeutic strategies.

DOI： 10.1007/s10147-021-01927-7

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記述言語：英語   出版者・発行元：SPRINGER  

More than 10 hereditary renal tumor syndromes (HRTSs) and related germline mutations have been reported with HRTS-associated renal and extrarenal manifestations with benign and malignant tumors. Radiologists play an important role in detecting solitary or multiple renal masses with or without extrarenal findings on imaging and may raise the possibility of an inherited predisposition to renal cell carcinoma, providing direction for further screening, intervention and surveillance of the patients and their close family members before the development of potentially lethal renal and extrarenal tumors. Renal cell carcinomas (RCCs) associated with von Hippel–Lindau disease are typically slow growing while RCCs associated with HRTSs, such as hereditary leiomyomatosis and renal cell carcinoma syndrome, are highly aggressive. Therefore, radiologists need to be familiar with clinical and imaging findings of renal and extrarenal manifestations of HRTSs. This article reviews clinical and imaging findings for the evaluation of patients with well-established HRTSs from a radiologist’s perspective to facilitate the clinical decision-making process for patient management.

DOI： 10.1007/s11604-021-01109-5

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記述言語：英語   出版者・発行元：NATURE RESEARCH  

DOI： 10.1038/s41598-021-93955-6

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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：ELSEVIER MASSON, CORP OFF  

Purpose: To evaluate the characteristics of needle artifacts and the accuracy of needle insertion using a 1.2 Tesla open magnetic resonance imaging (MRI) system in a phantom. Materials and methods: First, the apparent width of the needle on the MRI and the needle tip position error of 16- and 18-gauge MRI-compatible introducer needles and a 17-gauge cryoneedle were examined with different needle angles (0°, 30°, 45°, 60°, and 90°) to the main magnetic field (B0), sequence types (balanced steady-state acquisition with rewound gradient echo [BASG] and T2-weighted fast spin echo [FSE] sequence), and frequency encoding directions. Second, the accuracy of needle insertion was evaluated after 10 MRI fluoroscopy-guided insertions in a phantom. Results: The apparent needle widths was larger when the angle of the needle axis relative to B0 was larger. The needles appeared larger on BASG than on T2-weighted FSE images, with the largest apparent widths of 16-, 17-, and 18-gauge needles of 14.3, 11.6, and 11.0 mm, respectively. The apparent needle tip position was always more distal than the actual position on BASG images, with the largest longitudinal error of 4.0 mm. Meanwhile, the 16- and 18-gauge needle tips appeared more proximal on T2-weighted FSE images with right-to-left frequency encoding direction. The mean accuracy of MRI fluoroscopy-guided needle insertion was 3.1 mm. Conclusion: These experiments clarify the characteristics of needle artifacts in a 1.2 Tesla open MRI. With this system, the MRI fluoroscopy-guided needle insertion demonstrated an acceptable accuracy for clinical use.

DOI： 10.1016/j.diii.2020.12.007

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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：ELSEVIER  

Background: New therapeutic drugs have been developed for non-small cell lung cancer (NSCLC), and the prognosis of advanced NSCLC patients has improved. However, resistance to these drugs is a concern, and re-biopsy is necessary to determine the mechanism of drug resistance. There are many reports about the protocols for re-biopsy, including techniques such as bronchoscopy and computed tomography-guided needle biopsy (CTNB); however, there is no consensus on which method is optimal. Therefore, we retrospectively reviewed the bronchoscopy and CTNB re-biopsies conducted at our hospital. Methods: We retrospectively analyzed 79 cases of re-biopsies with bronchoscopy or CTNB in patients with NSCLC from January 2014 to December 2016 at our institute. Results: Forty-nine cases of bronchoscopy and 30 cases of CTNB were taken for re-biopsy. The diagnostic rates of bronchoscopy and CTNB were 83.7% and 100%, respectively (p = 0.023). The complication rates of bronchoscopy and CTNB were 18.4% and 36.7%, respectively (p = 0.11), with a statistically significant difference in the incidence of pneumothorax (0% vs. 23.3%, respectively; p < 0.01). Pneumothorax required drainage in 6.7% of all CTNB cases. There were no fatalities in either group. Conclusions: CTNB showed a higher diagnostic rate; however, it was associated with a higher rate of complications such as pneumothorax. Hence, the optimal modality must be determined individually for each patient.

DOI： 10.1016/j.resinv.2020.12.001

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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：SPRINGER JAPAN KK  

Background: Percutaneous cryoablation is widely used for the treatment of renal cell carcinoma. We prospectively evaluated the oncologic outcomes and safety of percutaneous cryoablation for the treatment of tumors ≤ 4 cm in diameter. Methods: We included patients aged ≥ 20 years, who had histologically proven renal cell carcinoma, tumor diameter ≤ 4 cm, a performance status of ≤ 1, acceptable laboratory parameters, were inoperable or refused to undergo surgery, and had signed a written informed consent. The primary endpoint was the cause-specific survival rate. The secondary endpoints were overall and progression-free survival, and adverse event frequency and grade. All procedures were percutaneously performed under computed tomography fluoroscopy guidance. Results: From October 2013 to October 2015, 33 patients (mean age: 68 ± 14 years; sex: six women, 27 men) were enrolled. The mean tumor diameter was 2.1 ± 0.6 (range 1.0–3.4) cm. The median follow-up period was 60.1 (range 18.4–76.6) months. One patient died of non-renal cell carcinoma-related disease 46 months after percutaneous cryoablation. The cause-specific and overall survival rates were 100% and 96.8% at 3 years, and 100% and 96.8% at 5 years, respectively. There was no local tumor progression or distant metastasis. The incidence of severe urological (urinary fistula and perinephric infection) and non-urological adverse events (increased creatine kinase and skin ulceration) was 6% each. Conclusion: Percutaneous cryoablation for renal cell carcinoma ≤ 4 cm in diameter achieved good tumor control with a low complication frequency.

DOI： 10.1007/s10147-020-01825-4

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記述言語：英語   出版者・発行元：SPRINGER  

DOI： 10.1007/s00270-020-02662-8

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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：OKAYAMA UNIV MED SCHOOL  

Palliative concurrent chemoradiotherapy (CCRT) is often administered to patients with stage III non-small cell lung cancer (NSCLC). We investigated the clinical outcomes of patients receiving palliative CCRT for NSCLC. Data of patients with NSCLC who underwent palliative CCRT (n=16), preoperative CCRT plus surgery (n=97), or definitive CCRT (n=48) were evaluated. In all groups, the concurrent chemotherapy regimens consisted of cisplatin and docetaxel. Rates of local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS), overall survival (OS), and prognosis were compared. The 2-year rates of LC, DMFS, PFS, and OS in 16 patients who underwent palliative CCRT were 44.4%, 12.5%, 12.5%, and 18.8%, respectively. Univariate analysis showed that palliative CCRT was associated with poor LC (p<0.001), DMFS (p<0.001), PFS (p<0.001), and OS (p<0.001) outcomes in patients who completed CCRT as a preoperative treatment and poor LC (p=0.01), DMFS (p=0.003), PFS (p=0.04), and OS (p=0.004) outcomes in patients who were considered for definitive CCRT. Although there were some long-term survivors, the clinical outcomes of palliative CCRT were significantly inferior to those of the ideal treatments. Therefore, careful determination of the appropriate treatment indications and further studies are warranted.

DOI： 10.18926/AMO/62218

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose: The purpose of this retrospective study was to determine the incidence of persistent patent artery after percutaneous cryoablation of renal cell carcinoma (RCC) and the relationship between patent arteries one month after cryoablation and early tumor progression. Materials and methods: One hundred and fifty-nine patients (112 men, 47 women; mean age, 63.6 ± 14.6 [SD] years; age range: 21–91 years) who underwent percutaneous cryoablation for 186 RCCs (mean diameter, 1.9 ± 0.6 [SD] cm; range: 0.7–4.0 cm) were retrospectively included. After cryoablation, patients underwent contrast-enhanced computed tomography (CT) with ≤ 2-mm slice thickness within one week from cryoablation, and at one, three, and six months. The time course of patent artery in the ablated renal parenchyma after cryoablation was the primary endpoint. The relationships between patent arteries one month after cryoablation and treatment effectiveness, tumor vascularity, tumor enhancement one month after cryoablation, tumor subtype, and renal function changes were evaluated as secondary endpoints. Results: CT showed patent arteries in the ablated renal parenchyma within one week in 166 RCCs (89.2%), at one month in 54 RCCs (29.0%), at three months in 8 RCCs (4.3%), and at six months in 2 RCCs (1.1%). The presence of patent artery one month after cryoablation was significantly associated with tumor enhancement at the same time point (P = 0.015). There was no association between patent arteries one month after cryoablation and treatment effectiveness (P = 0.693). Conclusion: Patent arteries in the ablated renal parenchyma are commonly observed on CT examination after percutaneous cryoablation of RCC. However, they gradually disappear and do not require specific treatment.

DOI： 10.1016/j.diii.2021.06.001

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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：OKAYAMA UNIV MED SCHOOL  

To assess the feasibility of needle tract ablation in liver tissue in ex vivo and in vivo animal models using a cryoprobe and electrosurgical device. The experimental device is made by inserting a cryoprobe through an introducer sheath for insulation, with 2-cm of probe tip projecting out. A beagle liver was punctured by the device, and electric current was applied at 30-W with the electrosurgical knife touching the non-insulated device base. The discolored area of cut surface along the device was evaluated in 5 application-time groups (5,10,15,20, or 25 seconds). An ex vivo experiment was performed to determine an ablation algorithm with an appropriate application time by comparison with radiofrequency ablation (RFA) results. Thereafter, an in vivo experiment was performed to verify the algorithm's feasibility. In the ex vivo model, the cut surface demonstrated different amounts of discolored area according to the application time. The total discolored area in the 20-seconds group was similar to that by RFA. In the in vivo model, the liver did not bleed, the total discolored area was similar to that ex vivo, and coagulation necrosis was confirmed by photomicrograph. Needle tract ablation can be performed using the experimental device and electrosurgical device.

DOI： 10.18926/AMO/61428

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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：OKAYAMA UNIV MED SCHOOL  

The aim of this study was to investigate whether volumetric positron emission tomography (PET) parameters are prognostic predictors in stage III non-small cell lung cancer patients receiving definitive concurrent chemoradiotherapy (CCRT) with cisplatin/docetaxel. Cases involving definitive CCRT were reviewed retrospectively, and the maximum standardized uptake value, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were calculated. The relationships between these PET parameters and prognosis were analyzed. MTV and TLG were significant predictors of distant metastasis-free survival (DMFS) (p = 0.0003 and 0.0005, respectively) and progression-free survival (PFS) (p = 0.001 and 0.0007, respectively). The three-year DMFS rates in patients with low and high MTV were 13.3% and 64.6%, respectively, and the corresponding values in those with low and high TLG were 13.3% and 65.2%, respectively. The three-year PFS rates in patients with low and high MTV were 13.3% and 57.8%, respectively, and the corresponding values in patients with low and high TLG were 13.3% and 57.8%, respectively. However, MTV and TLG were not predictors of local control or overall survival. We demonstrated that volumetric PET parameters were predictors of patients receiving definitive CCRT. Our findings contradict the findings of previous reports and warrant further research to validate them.

DOI： 10.18926/AMO/61429

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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：SPANDIDOS PUBL LTD  

The purpose of the present study was to clarify whether positron emission tomography/computed tomog-raphy (PET/CT) volumetric parameters were prognostic predictors of non-small cell lung cancer (NSCLC) treatment in patients who had undergone preoperative concurrent chemoradiotherapy (CCRT) and surgery. In the present study, retrospectively surveyed the data of patients with NSCLC who underwent preoperative CCRT and surgery at Okayama University Hospital (Okayama, Japan) between April 2006 and March 2018. The maximum standardized uptake value (SUVmax) and volumetric parameters, including metabolic tumor volume (MTV) and total lesion glycolysis (TLG), were calculated using PET/CT and the percentage decrease (Δ) in each parameter value post-CCRT. The SUVmax threshold for defining MTV was set at 2.5. Furthermore, the association between survival and PET parameter values was analyzed. A total of 52 patients were included in the present study. The median follow-up period was 50.65 months. In univariate analysis, ΔTLG was identified to be a significant predictor of progression-free survival (PFS; P=0.03). The 5-year PFS rates were 48.6 and 76.6% for patients with low ΔTLG and high ΔTLG, respectively. High ΔTLG was indicative of a higher overall survival rate (P=0.08). The present results suggest that ΔTLG calculated using PET/CT is a prognostic predictor of NSCLC treated using preoperative CCRT and surgery, and may help physicians determine treatment strategies.

DOI： 10.3892/mco.2021.2235

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To investigate whether muscle and adipose mass are associated with radiation pneumonitis (RP) in patients with non-small cell lung cancer undergoing preoperative concurrent chemoradiotherapy. PATIENTS AND METHODS: We calculated body mass index and determined skeletal muscle, psoas muscle, visceral adipose tissue (VAI), and subcutaneous adipose tissue indices, and visceral-to-subcutaneous adipose tissue area ratio for patients using computed tomography. We examined their relationship with grade 2 or more RP. RESULTS: Among 94 patients, 28 experienced grade 2 or more RP. On multivariate analysis, only VAI was associated with grade 2 or more RP (all p=0.026). The 6-month incidence rates of grade 2 or more RP were 21.4% and 36.8% in patients with VAI <39 and ≥39 cm 2 /m 2 , respectively. CONCLUSION: High visceral adipose mass is associated with grade 2 or more RP in patients undergoing preoperative concurrent chemoradiotherapy. Measuring visceral adipose mass may help to predict RP occurrence. Further studies are needed to validate our findings.

DOI： 10.21873/cdp.10009

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：一般社団法人 日本ロボット学会  

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DOI： 10.7210/jrsj.39.226

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担当区分：筆頭著者,　責任著者  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: To reveal trends in bone microarchitectural parameters with increasing spatial resolution on ultra-high-resolution computed tomography (UHRCT) in vivo and to compare its performance with that of conventional-resolution CT (CRCT) and micro-CT ex vivo. Methods: We retrospectively assessed 5 tiger vertebrae ex vivo and 16 human tibiae in vivo. Seven-pattern and four-pattern resolution imaging were performed on tiger vertebra using CRCT, UHRCT, and micro-CT, and on human tibiae using UHRCT. We measured six microarchitectural parameters: volumetric bone mineral density (vBMD), trabecular bone volume fraction (bone volume/total volume, BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp), and connectivity density (ConnD). Comparisons between different imaging resolutions were performed using Tukey or Dunnett T3 test. Results: The vBMD, BV/TV, Tb.N, and ConnD parameters showed an increasing trend, while Tb.Sp showed a decreasing trend both ex vivo and in vivo. Ex vivo, UHRCT at the two highest resolutions (1024- and 2048-matrix imaging with 0.25-mm slice thickness) and CRCT showed significant differences (p ≤ 0.047) in vBMD (51.4 mg/cm3 and 63.5 mg/cm3versus 20.8 mg/cm3), BV/TV (26.5% and 29.5% versus 13.8 %), Tb.N (1.3 l/mm and 1.48 l/mm versus 0.47 l/mm), and ConnD (0.52 l/mm3 and 0.74 l/mm3versus 0.02 l/mm3, respectively). In vivo, the 512- and 1024-matrix imaging with 0.25-mm slice thickness showed significant differences in Tb.N (0.38 l/mm versus 0.67 l/mm, respectively) and ConnD (0.06 l/mm3versus 0.22 l/mm3, respectively). Conclusions: We observed characteristic trends in microarchitectural parameters and demonstrated the potential utility of applying UHRCT for microarchitectural analysis.

DOI： 10.1186/s41747-019-0135-0

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掲載種別：研究論文（学術雑誌）  

Purpose: The purpose of this study was to retrospectively evaluate diagnostic yield, risk factors for diagnostic failure, and safety of image-guided core biopsy of renal tumors ≤ 2 cm. Materials and methods: Eighty-four biopsies of 84 renal tumors (mean size, 1.5 ± 0.4 [SD] cm; range, 0.6–2.0 cm) from 84 patients (53 men, 31 women; mean age, 61.7 ± 12.7 [SD] years; age range, 34–87 years) were included. All adverse events (AEs) were evaluated based on the CIRSE classification. The 84 procedures were classified as diagnostic or nondiagnostic. Multiple variables related to the patients, tumors, and procedures were assessed to identify variables associated with diagnostic failure. Results: All 84 biopsies (100%) were technically successful, defined as penetration of the target and acquisition of some specimens. Eighty (80/84; 95.2%) biopsy procedures were diagnostic and four (4/84; 4.8%) procedures were nondiagnostic. Among 80 diagnosed renal tumors, 71/80 (88.8%) tumors were malignant (49 clear cell renal cell carcinomas [RCCs], 14 papillary RCCs, 3 chromophobe RCCs, 3 metastatic renal cancers, 1 lymphoma, and 1 unclassified RCC) and 9/80 (11.2%) lesions were benign (5 angiomyolipomas, 3 oncocytomas, and 1 inflammatory lesion). No significant differences existed in any variables between the two groups. A total of 57 (57/84; 67.9%) procedures resulted in 56 Grade 1, 2 Grade 2, and 1 Grade 3 AEs. Conclusion: Image-guided biopsy of renal tumors ≤ 2 cm is safe and has a high diagnostic yield.

DOI： 10.1016/j.diii.2020.07.002

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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：ELSEVIER SCI LTD  

Objective: Since 2010, we have mainly performed surgical treatment following radiotherapy and concomitant intraarterial cisplatin (RADPLAT) for locally advanced maxillary sinus cancer (MSC). The present study investigated treatment results and pathological evaluations following RADPLAT for MSC. Methods: Pathological response to RADPLAT was evaluated using surgical specimens. Pathological response was graded in accordance with the classification method that Shimosato reported in 1964, as grade V (no tumor cells remain in any of section), grade IV, III, II, I, and 0. Five-year overall and disease-specific survival rates were estimated using Kaplan-Meier methods. Univariate analyses of correlations between recurrence of MSC and other clinicopathological parameters were evaluated using the chi-square or Fisher's exact tests. Result: 19 patients were enrolled in this study, 5 patients showed T3 disease and 14 had T4 disease. One patient demonstrated local recurrence and 3 patients experienced distant metastasis. The 5-year overall survival rate was 67.1% (T3, 50.0%; T4, 69.6%), and the 5-year disease-specific survival rate was 81.9% (T3, 100%; T4, 76.0%). Histological response was categorized as grade V in 9 cases. No significant risk factors for residual cancer were identified. Conclusion: Our study suggested that RADPLAT not only has a low risk of side effects, but also could represent an effective procedure for locally advanced MSC by pathological evaluation. Increasing the therapeutic intensity of RADPLAT might provide an effective modality to avoid highly invasive surgery.

DOI： 10.1016/j.anl.2020.04.004

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：英語   出版者・発行元：AME PUBL CO  

Breast cancer (BCa) frequently metastasizes to the bone. BCa patients with oligometastatic bone diseases have much more favorable outcomes than those with metastatic bone disease. Radiation therapy (RT), especially stereotactic body radiation therapy (SBRT), is advised for the treatment of patients with oligometastatic bone disease in other primary sites. This line of treatment provided favorable outcomes in patients and resulted in only mild toxicities. A similar strategy has been suggested for treatment of BCa patients with oligometastatic bone disease. BCa, bone-only, or high radiation dose are reported to have been associated with good outcomes in RT for metastatic disease. Furthermore, based on the guidelines provided by the BCa expert panel of the German Society for Radiation Oncology and members of the Working Party of Gynecologic Oncology Breast Committee and in line of the results obtained in other primary sites, our group supports the use of high-dose RT or SBRT for the treatment of BCa patients with oligometastatic bone disease. Additionally, the use of magnetic resonance imaging (MRI) for proper target volume definition and three-dimensional (3D) treatment planning especially for lesions of the trunk are essential for the treatment planning of RT. Of note, several clinical trials have combined RT with immune checkpoint inhibitors for the treatment of BCa patients with metastatic disease. Based on this, we anticipate that combined RT and ICI may serve as a better treatment modality for BCa patients with oligometastatic bone disease.

DOI： 10.21037/tcr.2020.01.35

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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：TAYLOR & FRANCIS LTD  

Purpose: To evaluate the histological findings in both tumor and surrounding non-tumoral liver parenchyma after trans-arterial chemoembolization with drug-eluting beads (DEB-TACE) for hepatocellular carcinoma (HCC) in patients who subsequently underwent hepatectomy. Material and methods: This study included six patients with an HCC (size 15–61 mm). DEB-TACE was performed using polyvinyl alcohol-based hydrogel microspheres loaded with epirubicin. Radiological tumor response was evaluated after DEB-TACE and before hepatectomy, according to the Modified Response Evaluation Criteria in Solid Tumors. Surgical specimens were histologically evaluated with hematoxylin and eosin, and elastic Van Gieson’s staining. Results: Segmental, sub-segmental, or partial hepatectomy were performed 14–58 days after DEB-TACE. There was no remarkable destructive change and minimal to absent inflammatory cell infiltration in the surrounding non-tumoral liver parenchyma. There was no evidence of biliary tract or arterial wall impairment. Complete and partial histological tumor necrosis were found in three cases, respectively, in agreement with the complete and partial responses seen during the radiological evaluation. Conclusion: Histological examination of resected liver specimens after DEB-TACE showed substantial tumor necrosis without any severe inflammatory or destructive changes in the non-tumoral liver parenchyma.

DOI： 10.1080/13645706.2019.1626250

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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：WILEY  

Background: Radiation pneumonitis (RP) is a major pulmonary adverse event of chest radiotherapy. The PACIFIC trial that identified durvalumab as an effective subsequent-line therapy after concurrent chemoradiotherapy (CCRT) found that patients with grade 2 or higher RP may have to be excluded from treatment under certain criteria. The purpose of this study was to investigate the relationship between grade ≥2 RP and the parameters of dose-volume histograms after CCRT with cisplatin/docetaxel for stage III non-small cell lung cancer and conduct a subset analysis of severe RP that can lead to the permanent discontinuation of treatment per the PACIFIC trial criteria to help determine treatment strategy. Methods: We calculated the percentage of the lung volume received at least 5 Gy (V5) and 20 Gy (V20), the mean lung dose (MLD), and the lung volume spared from a 5 Gy dose (VS5) to the total lung volume. Factors affecting the incidence of grade ≥2 RP were identified; severe RP was defined as grade ≥3 as well as grade 2 RP that required ≥10 mg prednisolone for at least 12 weeks. Results: This study included 45 patients. On univariate analysis, all parameters and total lung volume were found to be significant predictors of grade ≥2 RP (P =.001,.003,.03,.004, and.02, respectively). On multivariate analysis, V20 was a significant predictive factor of grade ≥2 RP (P =.007). Severe RP developed in 6 of 37 patients (16.2%) whose V20 values were 35% or lower. On univariate analysis, only V20 was a significant predictor of severe RP in these patients (P =.01). Conclusions: The best approach to reduce the rate of grade ≥2 RP is to maintain the V5, V20, MLD, and VS5 as low as possible during radiotherapy planning in patients receiving definitive CCRT with cisplatin/docetaxel.

DOI： 10.1002/cam4.3093

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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：ELSEVIER SCIENCE INC  

Purpose: To retrospectively compare the outcomes of radiofrequency (RF) ablation, stereotactic body radiotherapy (SBRT), and sublobar resection (SLR) in patients with stage I non–small-cell lung cancer (NSCLC) at a single center. Materials and Methods: Overall, 289 patients (38 RF ablation, 58 SBRT, and 193 SLR) were included. Kaplan-Meier curves were generated, multiple propensity score was estimated using a multinomial logistic regression model, and relationships between treatments and outcomes were assessed using a Cox proportional hazard model. Hazard ratios (HRs) for death from any cause and disease progression or death from any cause were examined by a crude model, an inverse probability of treatment weighting (IPTW) model, and an IPTW model adjusted for missing variables. Results: The 5-year overall and progression-free survival rates were 58.9% and 39.9%, respectively, for RF ablation; 42.0% and 34.9%, respectively, for SBRT; and 85.5% and 75.9%, respectively, for SLR. Significantly longer survival time and lower HR were observed for SLR than other treatments. However, after statistical adjustment, these relationships were not significant except for reduced HR of disease progression or death from any cause of SLR compared to RF ablation in the IPTW model. The median hospital stays for RF ablation, SBRT, and SLR were 6.5, 6, and 16 days, respectively. Adverse events of grade 3 or higher occurred only in 11 SLR cases. Conclusions: SLR achieved the longest survival. However, after statistical adjustment, there were no significant outcome differences among RF ablation, SBRT, and SLR, except for 1 model. RF ablation or SBRT may be alternative treatments for selected patients with early-stage NSCLC.

DOI： 10.1016/j.jvir.2019.11.035

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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：SPRINGER  

Purpose: To assess specimen weight difference of six types of semi-automatic cutting biopsy needles. Materials and methods: We compared 18- and 20-gauge needles, one aspiration-type (STARCUT® aspiration-type, TSK Laboratory, Tochigi, Japan) and five non-aspiration-type (MISSION®, BARD, AZ; SuperCore™, Argon Medical Devices, TX; Temno Evolution®, Care Fusion, IL; FINE CORE®, Toray Medical, Tokyo, Japan; Quick-Core®, Cook, IN) needles. Four biopsies were performed with each needle with the longest throw length on an excised bovine liver. The biopsies were repeated with new needles, four times with four different livers. STARCUT® was used both with and without aspiration. Results: Sixteen specimens were obtained with each needle. In needles of gauges, STARCUT® with aspiration provided the heaviest specimen and significantly heavier specimens were obtained with STARCUT® with aspiration (P < 0.05) than five non-aspiration-type needles. The specimen weight differed significantly (P < 0.001) among all 18- and 20-gauge needles. The specimen weights did not differ significantly between aspiration and non-aspiration biopsies with STARCUT® (6.32 vs. 5.97 mg with 18-gauge needle, P = 0.342; 1.95 vs. 1.92 mg with 20-gauge needle, P = 0.886). Conclusion: Although STARCUT® with aspiration provided the heaviest specimen, specimen weights were not significantly different between aspiration and non-aspiration biopsies. Secondary abstract: We assessed the specimen weight difference of six types of semi-automatic cutting biopsy needles. Significantly heavier specimens were obtained with STARCUT® with aspiration than the other needles. The specimen weight differed significantly among all 18- and 20-gauge needles but did not differ significantly between aspiration and non-aspiration biopsies with STARCUT®.

DOI： 10.1007/s11604-020-00935-3

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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：ELSEVIER IRELAND LTD  

Purpose: To evaluate the diagnostic yield and safety of computed tomography (CT) fluoroscopy-guided cutting needle biopsy (CNB) for pulmonary nodules ≤ 8 mm. Method: Data of CT fluoroscopy-guided CNB for pulmonary nodules ≤ 8 mm performed in a single institution were retrospectively analyzed. One hundred and seventeen biopsy procedures for 117 pulmonary nodules (mean size, 7.4 mm) in 114 patients were included in the study. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated. Univariate analyses were performed to elucidate the risk factors for diagnostic failure (i.e., non-diagnostic, false-positive, or false-negative results). Complications were graded per the Clavien-Dindo Classification. Results: One (0.9 %) non-diagnostic biopsy result was found. The diagnostic accuracy was 95.7 % (112/117). The sensitivity and specificity were 95.8 % (91/95) and 95.5 % (21/22), respectively. PPV and NPV were 98.9 % (91/92) and 87.5 % (21/24), respectively. Univariate analyses showed that nodules in the lower lobes (p = 0.006) and prone biopsy position (p = 0.021) were the significant risk factors for diagnostic failure. The incidence of pneumothorax requiring chest tube placement (Grade IIIa) was 6.8 % (8/117). No Grade IIIb or higher complications were observed. Conclusion: CT fluoroscopy-guided CNB for pulmonary nodules ≤ 8 mm showed a high diagnostic yield without severe complications.

DOI： 10.1016/j.ejrad.2020.108903

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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：SPRINGER  

Objectives: To evaluate the accuracy of robotic CT-guided out-of-plane needle insertion in phantom and animal experiments. Methods: A robotic system (Zerobot), developed at our institution, was used for needle insertion. In the phantom experiment, 12 robotic needle insertions into a phantom at various angles in the XY and YZ planes were performed, and the same insertions were manually performed freehand, as well as guided by a smartphone application (SmartPuncture). Angle errors were compared between the robotic and smartphone-guided manual insertions using Student’s t test. In the animal experiment, 6 robotic out-of-plane needle insertions toward targets of 1.0 mm in diameter placed in the kidneys and hip muscles of swine were performed, each with and without adjustment of needle orientation based on reconstructed CT images during insertion. Distance accuracy was calculated as the distance between the needle tip and the target center. Results: In the phantom experiment, the mean angle errors of the robotic, freehand manual, and smartphone-guided manual insertions were 0.4°, 7.0°, and 3.7° in the XY plane and 0.6°, 6.3°, and 0.6° in the YZ plane, respectively. Robotic insertions in the XY plane were significantly (p < 0.001) more accurate than smartphone-guided insertions. In the animal experiment, the overall mean distance accuracy of robotic insertions with and without adjustment of needle orientation was 2.5 mm and 5.0 mm, respectively. Conclusion: Robotic CT-guided out-of-plane needle insertions were more accurate than smartphone-guided manual insertions in the phantom and were also accurate in the in vivo procedure, particularly with adjustment during insertion. Key Points: • Out-of-plane needle insertions performed using our robot were more accurate than smartphone-guided manual insertions in the phantom experiment and were also accurate in the in vivo procedure. • In the phantom experiment, the mean angle errors of the robotic and smartphone-guided manual out-of-plane needle insertions were 0.4° and 3.7° in the XY plane (p < 0.001) and 0.6° and 0.6° in the YZ plane (p = 0.65), respectively. • In the animal experiment, the overall mean distance accuracies of the robotic out-of-plane needle insertions with and without adjustments of needle orientation during insertion were 2.5 mm and 5.0 mm, respectively.

DOI： 10.1007/s00330-019-06477-1

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掲載種別：研究論文（学術雑誌）  

Purpose: To prospectively evaluate the efficacy and safety of embolization using hydrogel-coated coils for the treatment of pulmonary arteriovenous malformations (PAVMs). Materials and methods: The outcomes of 21 PAVMs in 19 patients (3 men and 16 women; mean age, 58.8 ± 15.2 [SD] years; age range 14–78 years) treated by venous sac embolization (VSE) with additional feeding artery embolization were prospectively evaluated. For VSE, using one or more 0.018-inch hydrogel-coated coils was mandatory. Recanalization and/or reperfusion were evaluated by pulmonary arteriography 1 year after embolization. Results: The mean feeding artery and venous sac sizes were 4.0 mm and 8.5 mm, respectively. Embolization was successfully completed in 20/21 PAVMs, yielding a technical success rate of 95%. The feeding artery was also embolized in 17/20 successful PAVMs (85%). A technical failure occurred in one PAVM, where embolization was abandoned because of migration of one bare coil to the left ventricle. The mean numbers of hydrogel-coated coils and bare platinum detachable coils used for VSE were 3.3 ± 2.1 (SD) (range, 1–8) and 4.4 ± 3.9 (SD) (range, 1–17), respectively. The mean percentages of hydrogel-coated coils in number, length, and estimated volume were 42.9%, 33.3%, and 72.7% respectively. One patient with one PAVM was lost to follow-up after 3 months. Neither recanalization nor reperfusion was noted in the remaining 19 PAVMs (success rate, 19/19 [100%]). One grade 4 (coil migration) adverse event occurred, and it was treated without any sequelae. Conclusion: VSE using hydrogel-coated coils with additional feeding artery embolization is a safe and effective treatment for PAVM.

DOI： 10.1016/j.diii.2019.10.008

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記述言語：英語   出版者・発行元：SPRINGER  

DOI： 10.1007/s00270-019-02358-8

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Introduction: This was a prospective, first-in-human trial to evaluate the feasibility and safety of insertion of biopsy introducer needles with our robot during CT fluoroscopy–guided biopsy in humans. Materials and methods: Eligible patients were adults with a lesion ≥ 10 mm in an extremity or the trunk requiring pathological diagnosis with CT fluoroscopy–guided biopsy. Patients in whom at-risk structures were located within 10 mm of the scheduled needle tract were excluded. Ten patients (4 females and 6 males; mean [range] age, 72 [52–87] years) with lesions (mean [range] maximum diameter, 28 [14–52] mm) in the kidney (n = 4), lung (n = 3), mediastinum (n = 1), adrenal gland (n = 1), and muscle (n = 1) were enrolled. The biopsy procedure involved robotic insertion of a biopsy introducer needle followed by manual acquisition of specimens using a biopsy needle. The patients were followed up for 14 days. Feasibility was defined as the distance of ≤ 10 mm between needle tip after insertion and the nearest lesion edge on the CT fluoroscopic images. The safety of robotic insertion was evaluated on the basis of machine-related troubles and adverse events according to the Clavien-Dindo classification. Results: Robotic insertion of the introducer needle was feasible in all patients, enabling pathological diagnosis. There was no machine-related trouble. A total of 11 adverse events occurred in 8 patients, including 10 grade I events and 1 grade IIIa event. Conclusion: Insertion of biopsy introducer needles with our robot was feasible at several locations in the human body. Key Points: • Insertion of biopsy introducer needles with our robot during CT fluoroscopy–guided biopsy was feasible at several locations in the human body.

DOI： 10.1007/s00330-019-06409-z

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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：ELSEVIER IRELAND LTD  

Purpose: To prospectively investigate the incidence, severity, duration, and effect on lifestyle of post-ablation syndrome (PAS) after percutaneous renal cryoablation. Materials and Methods: We enrolled 39 patients (27 male and 12 female; mean age, 62 years) who underwent 40 CT-guided cryoablation sessions for pathologically proven renal cancer (mean size, 20 mm) between December 2015 and December 2017. Four symptoms attributable to PAS, i.e., fever, nausea, vomiting, malaise, and the synergistic effect of these symptoms on lifestyle by 21 days after ablation were evaluated using a questionnaire. Symptoms were graded according to the common toxicity criteria of adverse events. Results: The incidences of fever, nausea, vomiting, and malaise were 100% (40/40), 20% (8/40), 20% (8/40), and 63% (25/40), respectively. Most (78/81, 96%) symptoms had begun by day 2. The highest grade of fever per session was 0 (defined as ≥37.0 °C and <38.0 °C) (n = 24), 1 (n = 15), or 2 (n = 1); that of nausea was 2 (n = 8); that of vomiting was 1 (n = 7) or 3 (n = 1); and that of malaise was 1 (n = 14) or 2 (n = 11). Most (76/81, 94%) symptoms had resolved by day 8. The average values for the maximum scores of interference with general activity and work were 3.6 and 1.1, respectively. Conclusion: All symptoms were generally early-onset and self-limiting, with minimal impact on lifestyle and resolution by day 8. The clinical course and impact of PAS should be acknowledged by practitioners who manage patients undergoing renal cryoablation.

DOI： 10.1016/j.ejrad.2019.108750

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掲載種別：研究論文（学術雑誌）  

DOI： 10.22575/interventionalradiology.2019-0014

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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：AMER ROENTGEN RAY SOC  

OBJECTIVE. This study evaluated the utility of a deep learning method for determining whether a small (≤ 4 cm) solid renal mass was benign or malignant on multiphase contrastenhanced CT. MATERIALS AND METHODS. This retrospective study included 1807 image sets from 168 pathologically diagnosed small (≤ 4 cm) solid renal masses with four CT phases (unenhanced, corticomedullary, nephrogenic, and excretory) in 159 patients between 2012 and 2016. Masses were classified as malignant (n = 136) or benign (n = 32). The dataset was randomly divided into five subsets: Four were used for augmentation and supervised training (48,832 images), and one was used for testing (281 images). The Inception-v3 architecture convolutional neural network (CNN) model was used. The AUC for malignancy and accuracy at optimal cutoff values of output data were evaluated in six different CNN models. Multivariate logistic regression analysis was also performed. RESULTS. Malignant and benign lesions showed no significant difference of size. The AUC value of corticomedullary phase was higher than that of other phases (corticomedullary vs excretory, p = 0.022). The highest accuracy (88%) was achieved in corticomedullary phase images. Multivariate analysis revealed that the CNN model of corticomedullary phase was a significant predictor for malignancy compared with other CNN models, age, sex, and lesion size. CONCLUSION. A deep learning method with a CNN allowed acceptable differentiation of small (≤ 4 cm) solid renal masses in dynamic CT images, especially in the corticomedullary image model.

DOI： 10.2214/AJR.19.22074

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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：OKAYAMA UNIV MED SCHOOL  

We report a 47-year-old Japanese female with 10 previous treatments for multiple bilateral renal cell carcinoma (RCC) associated with von Hippel-Lindau disease. The 14-mm right lower pole renal tumor was in contact with the right ureter. Laparoscopic cryoablation was performed to protect the ureter wrapped with gauze. Computed tomography (CT) monitoring was used to confirm the precise ≥ 6 mm ice-ball margin. There was no local progression at 6-months post-surgery. The serum creatinine has been stable. This is apparently the first report of combined laparoscopic and CT monitoring of an ice-ball formation and its margin during cryoabla- tion for RCC.

DOI： 10.18926/AMO/60806

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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：OKAYAMA UNIV MED SCHOOL  

The aim of this study was to evaluate the ability of pretreatment 90-min 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to predict the extranodular spread of lymph node metastases in oral squamous cell carcinoma. We retrospectively reviewed the cases of 56 patients who underwent pretreatment 18F-FDG PET/CT and surgery with neck dissection. Maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis were measured for the 56 primary sites and maximum standardized uptake value was measured for 115 lymph node levels. Extranodular spread was present at 9 lymph node levels in 7 patients. Significant differences were found in metabolic tumor volume and total lesion glycolysis of the primary site, and in lymph node maximum standardized uptake value, between patients with and without extranodular spread (p<0.05). Combining primary site total lesion glycolysis and lymph node maximum standardized uptake volume at their respective optimal cutoffs, the sensitivity, specificity, and accuracy for predicting extranodular spread were 89%, 92%, and 92%, respectively. Pretreatment 18F-FDG PET/CT is useful for predicting extranodular spread in patients with oral squamous cell carcinoma. The combined use of primary site total lesion glycolysis and lymph node maximum standardized uptake value showed greater predictive value than either predictor singly.

DOI： 10.18926/AMO/58270

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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：OKAYAMA UNIV MED SCHOOL  

The aim of this study was to explore enhancement patterns of different types of primary lung cancers on 2-phase dynamic computed tomography (CT). This study included 217 primary lung cancer patients (141 adenocarcinomas [ADs], 48 squamous cell carcinomas [SCCs], 20 small cell lung carcinomas [SCLCs], and 8 others) who were examined using a 2-phase dynamic scan. Regions of interest were identified and mean enhancement values were calculated. After excluding the 20 SCLCs because these lesions had different clinical stages from the other cancer types, the mean attenuation values and subtractions between phases were compared between types of non-small cell lung carcinomas (NSCLCs) using the Kruskal-Wallis test. Late phase attenuation and attenuation of the late minus unenhanced phase (LMU) of SCCs were significantly higher than those of ADs (p<0.05). To differentiate SCC and AD in the late phase, a threshold of 80.21 Hounsfield units (HU) gave 52.9% accuracy. In LMU, a threshold of 52.16 HU gave 59.3% accuracy. Dynamic lung CT has the potential to aid in differentiating among NSCLC types.

DOI： 10.18926/AMO/58271

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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：OKAYAMA UNIV MED SCHOOL  

An aspiration-type semi-automatic cutting biopsy needle enables tissue cutting during application of negative pressure, which is expected to contribute to a larger amount of specimen. The aim of the present study was to evaluate this novel needle in a clinical setting. Patients who underwent image-guided percutaneous biopsy for lung or renal masses were enrolled. Cutting biopsy was performed with and without aspiration during each procedure. The specimens were weighed using an electronic scale. The weights were compared between specimens obtained with and without aspiration using a paired t-test. The data from 45 lung and 30 renal biopsy procedures were analyzed. In lung biopsy, the mean±standard deviation weights of specimens obtained with and without aspiration were 2.20±1.05 mg and 2.24±1.08 mg, respectively. In renal biopsy, the mean weights were 6.52±2.18 mg and 6.42±1.62 mg, respectively. The weights were not significantly different between specimens obtained with and without aspiration either in lung (p=0.799) or renal (p=0.789) biopsies. The application of negative pressure with the aspiration-type semi-automatic cutting biopsy needle did not contribute to an increase in the amount of the specimen obtained in lung and renal biopsies.

DOI： 10.18926/AMO/59951

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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：The Japanese Society of Interventional Radiology  

DOI： 10.22575/interventionalradiology.2020-0009

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：(有)科学評論社  

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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：FUJI TECHNOLOGY PRESS LTD  

In recent years, interventional radiology (IR) as a medical procedure has attracted considerable attention. Among the various IR techniques, computed to-mography (CT)-guided IR is performed by inserting a specific needle into a lesion under CT guidance, leading to this medical procedure being less invasive. How-ever, as the procedure requires the doctor to be positioned near the CT, radiation exposure may be a ma-jor concern. To overcome this problem, we developed a remote-controlled robotic system for needle insertion during CT-guided interventional procedures. The cur-rent needle holder for the robot is risky in that it might hurt a patient since a needle is always held firmly even when the patient moves. To solve this problem, we designed and fabricated a gripper with variable stiffness through jamming transition. Subsequently, we conducted experiments to investigate the effect of elements constituting the gripper to improve its performance.

DOI： 10.20965/jrm.2020.p0692

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記述言語：日本語   出版者・発行元：金原出版(株)  

症例は40歳代前半女性で、腹痛の精査目的で施行されたCT検査で左卵巣に4cm大の腫瘤を認め、当院婦人科に紹介となった。骨盤部MRIでは左卵巣から外方性に発育した約4.2cm大の充実性腫瘤を認めた。辺縁はほぼ平滑で境界明瞭、内部はT2強調像でやや低信号で拡散低下を示していた。Dynamic MRIでは漸増性に子宮筋層と同程度の造影効果を認めた。子宮内膜に肥厚は認めなかった。臨床、画像所見から腫瘤の鑑別として悪性リンパ腫や性索間質性腫瘍が挙げられた。左付属器切除術が施行され、術中迅速病理組織検査で成人型顆粒膜細胞腫と診断され、腹式単純子宮全摘術、右付臓器切除術、大網切除術が追加された。腫瘍細胞は比較的均一でN/C比は高く、円形または楕円形の核の一部に核溝がみられ、成人型顆粒膜細胞腫と診断された。

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記述言語：日本語   出版者・発行元：(一社)日本コンピュータ外科学会  

著者らは、術者の被ばく量低減を目的として、遠隔操作型のCT透視ガイド下針穿刺ロボット(Zerobot)の研究開発を開始している。今回、動物実験のCT画像をもとに術者である医師がロボットを遠隔操作してブタの体内にある標的に対して穿刺を行う場合に、針と標的との位置関係によってどのように針の軌道修正の作業を行うのか調査した。Zerobotを用いて、X軸、Y軸、Z軸の三つの直動軸で三次元方向の並進運動を行い、針の位置を決定した。A軸、B軸の二つの回転軸で回転運動を行い、針の姿勢を決定した。調査に使用したデータはブタを用いた穿刺精度試験で得られたものであった。ロボットを医師が遠隔操作することによる穿刺において、針が標的に近づくにつれ修正回数は指数的に増加していることが分かった。なお、残りの穿刺深さが約10mmとなるのをピークに、それ以降はA軸とB軸の修正回数は減少し、一方で刺し直し回数が増加している様子が観察された。合計60回の穿刺のうち、A軸の修正は110回、B軸の修正は66回、刺し直しは37回であった。自動穿刺シミュレーションの結果、穿刺経路と針との距離と角度がゼロに収束しており、針先を三次元的な穿刺経路に追従させることができることを確認した。針が標的に近づくにしたがって穿刺速度が減速していることが示された。

DOI： 10.5759/jscas.22.14

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記述言語：日本語   出版者・発行元：金原出版(株)  

症例は60歳代男性で、骨髄異形成症候群を治療中であったが、輸血依存状態の増悪を認めたため同種骨髄移植目的に当院紹介となった。入院時のCT所見から、右主肺動脈塞栓症の疑いとして入院直後より抗凝固療法を開始した。入院4日後に18F-FDG-PET/CTを撮影したところ、CTで認められた腫瘤へ一致してSUVmax=6.12のFDG集積が認められた。縦隔や右肺門部リンパ節でもSUVmax=6.62のFDG集積亢進を認めた。入院14日目に撮影された造影MRIでは、脂肪抑制T1強調像で病変は低信号を示し、造影後では腫瘤に造影効果は認められなかった。入院時CTと比較して病変に縮小は認められなかった。FDGの高集積や腫瘤の縮小が認められなかったことから腫瘍性病変の可能性が疑われ、確定診断のためカテーテル吸入生検が行われた。吸引組織は血栓であったが、内部に真菌菌糸が認められ、真菌血栓症と診断された。このため、抗凝固療法は継続のうえで抗真菌薬を投与したが、その後も炎症反応高値が遷延した。同種骨髄移植の適応はないものと判断されたため、紹介元の病院へ転院となったが、抗真菌薬による治療開始後約2ヵ月で永眠された。

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掲載種別：研究論文（学術雑誌）  

Purpose: The purpose of this study was to analyze the outcome of patients with Birt–Hogg–Dubé (BHD) syndrome who underwent percutaneous thermal ablation of renal cell carcinoma (RCC). Materials and methods: Six patients with genetically proven BHD syndrome who underwent one or more sessions of percutaneous thermal ablation for the treatment of RCC were included. There were 4 men and 2 women, with a mean age of 57.3 ± 7.5 [SD] years (range: 44–67 years). A total of 29 RCCs (1–16 tumors per patient) were treated during 20 thermal ablation sessions (7 with radiofrequency ablation and 13 with cryoablation). Outcomes of thermal ablation therapy were assessed, including technical success, adverse events, local tumor progression, development of metastases, survival after thermal ablation, and changes in renal function. Results: Technical success was achieved in all ablation sessions (success rate, 100%). No grade 4 or 5 adverse events were observed. All patients were alive with no distant metastasis during a median follow-up period of 54 months (range: 6–173 months). No local tumor progression was found. The mean decrease in estimated glomerular filtration rate during follow-up was 10.7 mL/min/1.73 m2. No patients required dialysis or renal transplantation. Conclusion: Radiofrequency ablation and cryoablation show promising results for the treatment of RCCs associated with BHD syndrome. Percutaneous thermal ablation may be a useful treatment option for this rare hereditary condition.

DOI： 10.1016/j.diii.2019.06.009

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DOI： 10.1016/j.diii.2019.06.001

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DOI： 10.1016/j.diii.2019.04.002

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Intrapulmonary solitary fibrous tumors (SFTs) are extremely rare neoplasms. We report a case of an intrapulmonary SFT and describe the findings of computed tomography (CT) and F-18 fluorodeoxyglucose positron emission tomography. The case indicates that a benign intrapulmonary SFT can present as a ground-glass nodule in the early stages of disease and may appear as a well-defined, lobular, homogeneously enhanced mass with slow growth on chest CT images. To our knowledge, this is the first report describing the natural course of an intrapulmonary SFT over 16 years based on the findings of chest CT and F-18 fluorodeoxyglucose positron emission tomography/CT.

DOI： 10.1016/j.radcr.2019.03.023

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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：LIPPINCOTT WILLIAMS & WILKINS  

BACKGROUND The clinical significance of contrast extravasation (CE) on computed tomography (CT) of the psoas major muscle after blunt torso trauma and the optimal management of patients requiring transcatheter arterial embolization (TAE) of the lumbar artery have not been well elucidated. The aim of this study was to investigate the impact of CE on CT to determine the need for TAE of the lumbar artery. METHODS We examined a single-center retrospective cohort of blunt torso trauma patients who underwent contrast-enhanced CT from 2008 to 2017. Basic demographics and clinical data were obtained, including the number of lumbar transverse process fractures (LTPFs) and maximum psoas major muscle hematoma (PMMH) size and ratio. Maximum PMMH size was analyzed by measuring the cross-sectional area of hematoma size at the level of CE. Psoas major muscle hematoma size ratio was obtained by dividing maximum PMMH size by psoas major muscle size of the unaffected side at the same slice level. RESULTS A total of 762 patients were included. One hundred seventeen patients had LTPFs and/or PMMH. Of 117 patients, 25 had CE on CT of the psoas major muscle and had significantly higher rates of older age and severe injury compared with those without CE. Of the 25 patients with CE, 13 required TAE of the lumbar artery. Patients who required TAE had a significantly higher number of LTPFs (4 vs. 2, p = 0.011) and higher PMMH size ratio (2.10 vs. 1.32, p = 0.016). Psoas major muscle hematoma size ratio revealed moderate accuracy (area under the receiver operating characteristic curve, 0.782). CONCLUSIONS Approximately half of the blunt torso trauma patients with CE on CT of the psoas major muscle will require TAE of the lumbar artery. Higher number of LTPFs and larger PMMH size can be a predictor of the need for TAE of the lumbar artery among patients with CE on CT. LEVEL OF EVIDENCE Therapeutic/care management, level IV.

DOI： 10.1097/TA.0000000000002121

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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：SPRINGER  

Purpose: To evaluate the safety and efficacy of cryoablation for renal cell carcinoma (RCC) in patients with stage 4 or 5 non-dialysis chronic kidney disease (CKD). Materials and methods: This retrospective multicenter study included patients with maximum tumor diameter ≤ 4 cm, estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m 2 , in whom cryoablation was performed percutaneously with curative intent between July 2011 and May 2016. Results: Of 541 patients who underwent renal tumor cryoablation, 17 (3.1%; 4 women, 13 men; mean age 70.1 ± 10.6 years) with stage 4 or 5 non-dialysis CKD were included in this study. The pre-cryoablation eGFR was 22.5 ± 6.3 ml/min/1.73 m 2 . The mean tumor diameter was 2.8 ± 0.7 cm. No Grade 3 or higher adverse events occurred post-cryoablation. The eGFR at each time point was significantly lower than that before treatment. One patient required hemodialysis initiation at 21 months post-procedure. None of the patients showed residual RCC at their last follow-up. Conclusion: Cryoablation of RCC is safe in patients with stage 4 or 5 non-dialysis CKD and yields treatment results comparable to those in patients without CKD. This treatment could be completed without the early initiation of hemodialysis after the procedure.

DOI： 10.1007/s11604-019-00821-7

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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：OKAYAMA UNIV MED SCHOOL  

Nephron-sparing treatment should be offered whenever possible to avoid dialysis in allograph cases. Cryoablation is a new treatment option for treating small-sized renal cell cancer (RCCs). We report a case of RCC arising in a kidney allograft treated by cryoablation. To our knowledge, this is the first case in Asia of RCC in a renal allograft treated using cryoablation. Contrast-enhanced CT-guided percutaneous renal needle biopsy and cryoablation were used to identify the RCC, which could not be identified by other techniques. The postoperative course was uneventful. Contrast-enhanced CT also showed no recurrence or metastases at the 6-month follow-up.

DOI： 10.18926/AMO/56871

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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：NAGOYA UNIV, SCH MED  

There has been growing interest in magnetic resonance imaging (MRI)-guided interventional procedures such as percutaneous needle biopsy. Although open MRI is preferable for MRI-guided procedures in terms of patient accessibility, its inferior imaging capability due to lower field strength is a substantial limitation. In this situation, the high-field (1.2T) open MRI has recently become available. This novel MRI system is expected to provide excellent image quality as well as good patient accessibility, potentially contributing to safe and accurate device manipulation. This trial is designed to investigate the feasibility of MRI-guided percutaneous needle biopsy with this system. Patients with lesions needing percutaneous needle biopsy for pathological diagnosis are included. The enrollment of ten patients is intended. The primary endpoint of this study is the feasibility of biopsy needle insertion under real-time MR-fluoroscopy guidance based on the presence of the notch of the biopsy needle within the target lesion. The secondary endpoints are adverse events, device failures, and success of specimen acquisition. Once the feasibility of MRI-guided biopsy with 1.2T open MRI is validated by this study, it may potentially encourage widespread use of MRI-guidance for biopsy procedures. Furthermore, it may lead to development of the other MRI-guided interventional procedures using this MRI system.

DOI： 10.18999/nagjms.81.3.463

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

手術の領域ではロボット手術がどんどん広がっているが、CTガイド下IVRの領域においても世界的にみればロボット化の流れが進んでいる。本稿では、世界におけるCTガイド下IVR用ロボットの開発状況および筆者らが開発しているロボットについて紹介する。また最後に、今後のIVR医とロボットとのかかわり方について私見を述べる。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞●産科出血は出血が持続すれば容易にDICに陥るので,治療方針の迅速な決定が必要である.●出血源が明らかであれば選択的に塞栓を行い,選択的に塞栓できない場合や出血源が明らかでなければ両側子宮動脈を塞栓するのが基本である.骨盤内血管には豊富な吻合が存在することを認識する.●500μm以下の塞栓物質は子宮内膜壊死をきたすリスクがあるため使用しない.●DICに陥っている場合には,液体塞栓物質(NBCA)での塞栓が必要になることがある.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Percutaneous cryoablation for renal tumors may be associated with rare complications such as injury to the ureter. A 65-year-old woman underwent percutaneous cryoablation after a transcatheter arterial embolization using lipiodol and ethanol for left renal oncocytoma. Two months after the percutaneous cryoablation, computed tomography images showed left hydronephrosis caused by high-density debris, which was assumed to be sloughed tumor with lipiodol accumulation in the left ureter. A stent was placed in the left ureter to enhance the drainage of urine and the necrotic cell debris. Three months later, the ureteral stent was removed, and she remained asymptomatic during the follow-up period of 4 months. We should consider the possibility of urinary tract obstruction by sloughed tumor when hydronephrosis occurs after percutaneous cryoablation of a renal tumor.

DOI： 10.1016/j.radcr.2018.08.014

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Severe anaphylactic reactions to an intravenous nonionic iodine contrast medium (NICM) are uncommon but can result in permanent morbidity or death if not managed appropriately. An anaphylactic reaction to an NICM typically manifests as clinical symptoms that include an itchy nose, sneezing, and skin redness. To our knowledge, a rapid change in the caliber of the inferior vena cava (IVC) during multiphasic contrast-enhanced computed tomography (CT) has not been reported. Here, we report the computed tomographic findings in three cases of hypovolemic shock caused by an anaphylactic reaction to an NICM. We suspect that a decrease in caliber of the IVC during multiphasic contrast-enhanced CT may be a predictor of an allergic-like reaction to an NICM. Patients in whom physicians and radiographers detect a rapid caliber change in the IVC during multiphasic contrast-enhanced CT should be managed carefully.

DOI： 10.1016/j.radcr.2018.07.002

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During video-assisted thoracic surgery (VATS), localization is sometimes needed to detect a target lesion that is too small and/or too far from the pleura. In 1995, Kanazawa et al. developed short hookwire and suture system. Since then, this system has been placed often for selected targets before VATS in Japan. This short hookwire and suture system is a representative preoperative localization method and the placement procedure is well-established. Its placement success rates are very high (range: 97.6%–99.6%), and dislodgement of this short hookwire rarely occurs with an incidence of 0.4%–2.5%. The most common complication of short hookwire placement is pneumothorax (incidence: 32.1%–68.1%), followed by pulmonary hemorrhage (incidence: 8.9%–41.6%). Complications are frequent; however, most complications are minor and asymptomatic.

DOI： 10.1016/j.diii.2018.04.001

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER IRELAND LTD  

Objective: To evaluate the accuracy of robotic insertion of various ablation needles at various locations under computed tomography (CT) guidance in swine. Materials and methods: The robot was used for CT-guided insertion of four ablation needles, namely a single internally cooled radiofrequency ablation (RFA) needle (Cool-tip), a multi-tined expandable RFA needle (LeVeen), a cryoablation needle (IceRod), and an internally cooled microwave ablation needle (Emprint). One author remotely operated the robot with the operation interface in order to orient and insert the needles under CT guidance. Five insertions of each type of ablation needle towards 1.0-mm targets in the liver, kidney, lung, and hip muscle were attempted on the plane of an axial CT image in six swine. Accuracy of needle insertion was evaluated as the three-dimensional length between the target centre and needle tip. The accuracy of needle insertion was compared according to the type of needle used and the location using one-way analysis of variance. Results: The overall mean accuracy of all four needles in all four locations was 2.8 mm. The mean accuracy of insertion of the Cool-tip needle, LeVeen needle, IceRod needle, and Emprint needle was 2.8 mm, 3.1 mm, 2.5 mm, and 2.7 mm, respectively. The mean accuracy of insertion into the liver, kidney, lung, and hip muscle was 2.7 mm, 2.9 mm, 2.9 mm, and 2.5 mm, respectively. There was no significant difference in insertion accuracy among the needles (P =.38) or the locations (P =.53). Conclusion: Robotic insertion of various ablation needles under CT guidance was accurate regardless of type of needle or location in swine.

DOI： 10.1016/j.ejrad.2018.06.006

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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：LIPPINCOTT WILLIAMS & WILKINS  

Rationale: Hydronephrosis caused by retroperitoneal hematoma after a seatbelt injury is a unique clinical entity. Patient concerns: A 21-year-old man, who had been wearing a seatbelt, was brought to our hospital after a motor vehicle collision, complaining of abdominal pain. Computed tomography (CT) revealed retroperitoneal hematoma in the upper pelvic region. Since he was hemodynamically stable throughout admission, he was managed conservatively. Seventeen days after initial discharge, the patient revisited our emergency department due to right back pain. Diagnoses: CT scans indicated retroperitoneal hematoma growth resulting in hydronephrosis of the right kidney. Interventions: Laparoscopic drainage of the retroperitoneal hematoma was successfully performed. Outcomes: His symptoms resolved after the surgery. Follow-up CT scans three months later demonstrated complete resolution of the hydronephrosis and retroperitoneal hematoma. Lessons: Our case highlights a patient with delayed hydronephrosis because of retroperitoneal hematoma expansion after a seatbelt injury.

DOI： 10.1097/MD.0000000000011022

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記述言語：英語   出版者・発行元：SPRINGER  

DOI： 10.1007/s00270-018-1879-2

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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：SPRINGER  

Objectives: To retrospectively evaluate the technical success of computed tomography fluoroscopy-guided short hookwire placement before video-assisted thoracoscopic surgery and to identify the risk factors for initial placement failure. Methods: In total, 401 short hookwire placements for 401 lesions (mean diameter 9.3 mm) were reviewed. Technical success was defined as correct positioning of the hookwire. Possible risk factors for initial placement failure (i.e., requirement for placement of an additional hookwire or to abort the attempt) were evaluated using logistic regression analysis for all procedures, and for procedures performed via the conventional route separately. Results: Of the 401 initial placements, 383 were successful and 18 failed. Short hookwires were finally placed for 399 of 401 lesions (99.5%). Univariate logistic regression analyses revealed that in all 401 procedures only the transfissural approach was a significant independent predictor of initial placement failure (odds ratio, OR, 15.326; 95% confidence interval, CI, 5.429–43.267; p < 0.001) and for the 374 procedures performed via the conventional route only lesion size was a significant independent predictor of failure (OR 0.793, 95% CI 0.631–0.996; p = 0.046). Conclusions: The technical success of preoperative short hookwire placement was extremely high. The transfissural approach was a predictor initial placement failure for all procedures and small lesion size was a predictor of initial placement failure for procedures performed via the conventional route. Key points: • Technical success of preoperative short hookwire placement was extremely high. • The transfissural approach was a significant independent predictor of initial placement failure for all procedures. • Small lesion size was a significant independent predictor of initial placement failure for procedures performed via the conventional route.

DOI： 10.1007/s00330-017-5176-2

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：(一社)日本インターベンショナルラジオロジー学会  

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掲載種別：研究論文（学術雑誌）  

Objective: To retrospectively evaluate the safety, diagnostic yield, and risk factors of diagnostic failure of computed tomography (CT) fluoroscopy-guided biopsies of anterior mediastinal masses. Materials and methods: Biopsy procedures and results of anterior mediastinal masses in 71 patients (32 women/39 men; mean [± standard deviation] age, 53.8 ± 20.0 years; range, 14–88 years) were analyzed. Final diagnoses were based on surgical outcomes, imaging findings, or clinical follow-up findings. The biopsy results were compared with the final diagnosis, and the biopsy procedures grouped by pathologic findings into diagnostic success and failure groups. Multiple putative risk factors for diagnostic failure were then assessed. Results: Seventy-one biopsies (71 masses; mean size, 67.5 ± 27.3 mm; range 8.6–128.2 mm) were analyzed. We identified 17 grade 1 and one grade 2 adverse events (25.4% overall) according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Sixty-nine biopsies (97.2%) provided samples fit for pathologic analysis. Diagnostic failure was found for eight (11.3%) masses; the 63 masses diagnosed successfully included thymic carcinoma (n = 17), lung cancer (n = 14), thymoma (n = 12), malignant lymphoma (n = 11), germ cell tumor (n = 3), and others (n = 6). Using a thinner needle (i.e., a 20-gauge needle) was the sole significant risk factor for diagnostic failure (P = 0.039). Conclusion: CT fluoroscopy-guided biopsy of anterior mediastinal masses was safe and had a high diagnostic yield; however, using a thinner biopsy needle significantly increased the risk of a failed diagnosis.

DOI： 10.1016/j.diii.2017.10.007

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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：SPRINGER  

Objectives: To evaluate retrospectively the diagnostic yield, safety, and risk factors for diagnostic failure of computed tomography (CT) fluoroscopy-guided renal tumour biopsy. Methods: Biopsies were performed for 208 tumours (mean diameter 2.3 cm; median diameter 2.1 cm; range 0.9–8.5 cm) in 199 patients. One hundred and ninety-nine tumours were ≤4 cm. All 208 initial procedures were divided into diagnostic success and failure groups. Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for diagnostic failure. Results: After performing 208 initial and nine repeat biopsies, 180 malignancies and 15 benign tumours were pathologically diagnosed, whereas 13 were not diagnosed. In 117 procedures, 118 Grade I and one Grade IIIa adverse events (AEs) occurred. Neither Grade ≥IIIb AEs nor tumour seeding were observed within a median follow-up period of 13.7 months. Logistic regression analysis revealed only small tumour size (≤1.5 cm; odds ratio 3.750; 95% confidence interval 1.362–10.326; P = 0.011) to be a significant risk factor for diagnostic failure. Conclusion: CT fluoroscopy-guided renal tumour biopsy is a safe procedure with a high diagnostic yield. A small tumour size (≤1.5 cm) is a significant risk factor for diagnostic failure. Key points: • CT fluoroscopy-guided renal tumour biopsy has a high diagnostic yield. • CT fluoroscopy-guided renal tumour biopsy is safe. • Small tumour size (≤1.5 cm) is a risk factor for diagnostic failure.

DOI： 10.1007/s00330-017-4969-7

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担当区分：筆頭著者,　責任著者   記述言語：英語   出版者・発行元：OKAYAMA UNIV MED SCHOOL  

Since 2012, we have been developing a remote-controlled robotic system (Zerobot®) for needle insertion during computed tomography (CT)-guided interventional procedures, such as ablation, biopsy, and drainage. The system was designed via a collaboration between the medical and engineering departments at Okayama University, including various risk control features. It consists of a robot with 6 degrees of freedom that is manipulated using an operation interface to perform needle insertions under CT-guidance. The procedure includes robot positioning, needle targeting, and needle insertion. Phantom experiments have indicated that robotic insertion is equivalent in accuracy to manual insertion, without physician radiation exposure. Animal experiments have revealed that robotic insertion of biopsy introducer needles and various ablation needles is safe and accurate in vivo. The first in vivo human trial, therefore, began in April 2018. After its completion, a larger clinical study will be conducted for commercialization of the robot. This robotic procedure has many potential advantages over a manual procedure: 1) decreased physician fatigue; 2) stable and accurate needle posture without tremor; 3) procedure automation; 4) less experience required for proficiency in needle insertion skills; 5) decreased variance in technical skills among physicians; and 6) increased likelihood of performing the procedure at remote hospitals (i.e., telemedicine).

DOI： 10.18926/AMO/56370

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

肺癌に対するIVRとして、塞栓術や動注療法、ablation治療が挙げられるが、本稿では、そのなかでも局所制御に優れたablation治療について述べる。診断医に知ってほしい治療前後の画像変化や合併症像を提示する。(著者抄録)

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：岡山医学会  

DOI： 10.4044/joma.130.51

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：一般社団法人日本インターベンショナルラジオロジー学会  

Computed tomography (CT) fluoroscopy-guided interventions such as ablation and biopsy are performed by inserting a specific needle into the lesion under CT fluoroscopy-guidance While those have various advantages including less invasive procedure, short procedure time, and low cost, a major concern to physicians is intraprocedural radiation exposure. In order to address this concern, we hypothesized that a remotely controllable robot could free physicians from radiation exposure. Since 2012, therefore, we have developed such a robot (Zerobot^&reg;), the tasks of which are to hold, target, and insert a needle under CT-guidance by a physician's remotely manipulating a controller. The robot is floor-mounted and specially designed for a sliding-gantry CT scanner for CT-guided interventions. Phantom experiments showed that robotic needle insertion was equivalent in accuracy without exposing the physician to radiation, in comparison to manual insertion. Animal experiments showed that it was feasible, safe, and accurate in an in vivo procedure. In this article, we provide an overview of the robot, including future perspectives.

DOI： 10.11407/ivr.33.19

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記述言語：日本語   出版者・発行元：金原出版(株)  

症例は73歳女性で、肉眼的血尿、右下腹部痛を主訴とした。近医造影CTで右腎の腎血管筋脂肪腫と膀胱タンポナーデを認め、保存的治療で軽快したが、塞栓術の適応について紹介受診した。dynamic CTでは右腎腹側の腎盂からはやや離れた位置に3.3cm大の腎血管筋脂肪腫を認め、腎血管筋脂肪腫に対する塞栓術を計画して血管造影を行ったところ、偶発的に異なる部位に腎動静脈奇形を発見した。同部からのCT arteriographyでは腎盂直下主体に拡張蛇行する異常血管を認め、cirsoid typeの腎動静脈奇形と判断して、まず腎血管筋脂肪腫に対する塞栓術を行い、続いて腎動静脈奇形に対する塞栓術を行った。塞栓術後12ヵ月の時点で血尿の再発は認めない。原因不明の膀胱タンポナーデをきたした場合には、腎動静脈奇形も念頭に置いて診断を進める必要があると思われた。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01565&link_issn=&doc_id=20180904090014&doc_link_id=10.18888%2Frp.0000000524&url=https%3A%2F%2Fdoi.org%2F10.18888%2Frp.0000000524&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(一社)日本コンピュータ外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本コンピュータ外科学会  

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：金原出版(株)  

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：RADIOLOGICAL SOC NORTH AMERICA  

Purpose: To evaluate the accuracy of the remote-controlled robotic computed tomography (CT)-guided needle insertion in phantom and animal experiments. Materials and Methods: In a phantom experiment, 18 robotic and manual insertions each were performed with 19-gauge needles by using CT fluoroscopic guidance for the evaluation of the equivalence of accuracy of insertion between the two groups with a 1.0-mm margin. Needle insertion time, CT fluoroscopy time, and radiation exposure were compared by using the Student t test. The animal experiments were approved by the institutional animal care and use committee. In the animal experiment, five robotic insertions each were attempted toward targets in the liver, kidneys, lungs, and hip muscle of three swine by using 19-gauge or 17-gauge needles and by using conventional CT guidance. The feasibility, safety, and accuracy of robotic insertion were evaluated. Results: The mean accuracies of robotic and manual insertion in phantoms were 1.6 and 1.4 mm, respectively. The 95% confidence interval of the mean difference was 20.3 to 0.6 mm. There were no significant differences in needle insertion time, CT fluoroscopy time, or radiation exposure to the phantom between the two methods. Effective dose to the physician during robotic insertion was always 0 μSv, while that during manual insertion was 5.7 μSv on average (P < .001). Robotic insertion was feasible in the animals, with an overall mean accuracy of 3.2 mm and three minor procedure-related complications. Conclusion: Robotic insertion exhibited equivalent accuracy as manual insertion in phantoms, without radiation exposure to the physician. It was also found to be accurate in an in vivo procedure in animals.

DOI： 10.1148/radiol.2017162856

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DOI： 10.1016/j.diii.2017.02.008

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掲載種別：研究論文（学術雑誌）  

Purpose To retrospectively evaluate the feasibility, safety, and efficacy of radiofrequency ablation (RFA) of lung tumors located near the diaphragm. Materials and methods A total of 26 patients (15 men, 11 women; mean age, 61.5 years ± 13.0 [SD]) with a total of 29 lung tumors near the diaphragm (i.e., distance < 10 mm) were included. Mean tumor diameter was 11.0 mm ± 5.3 (SD) (range, 2–23 mm). Efficacy of RFA, number of adverse events and number of adverse events with a grade ≥ 3, based on the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0, were compared between patients with lung tumors near the diaphragm and a control group of patients with more distally located lung tumors (i.e., distance ≥ 10 mm). Results RFA was technically feasible for all tumors near the diaphragm. Four grade 3 adverse events (1 pneumothorax requiring pleurodesis and 3 phrenic nerve injuries) were observed. No grade ≥ 4 adverse events were reported. The median follow-up period for tumors near the diaphragm was 18.3 months. Local progression was observed 3.3 months after RFA in 1 tumor. The technique efficacy rates were 96.2% at 1 year and 96.2% at 2 years and were not different, from those observed in control subjects (186 tumors; P = 0.839). Shoulder pain (P < 0.001) and grade 1 pleural effusion (P < 0.001) were more frequently observed in patients with lung tumor near the diaphragm. The rates of grade ≥ 3 adverse events did not significantly differ between tumors near the diaphragm (4/26 sessions) and the controls (7/133 sessions) (P = 0.083). Conclusion RFA is a feasible and effective therapeutic option for lung tumors located near the diaphragm. However, it conveys a higher rate of shoulder pain and asymptomatic pleural effusion by comparison with more distant lung tumors.

DOI： 10.1016/j.diii.2017.01.008

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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：ELSEVIER SCIENCE INC  

Purpose To retrospectively evaluate the effect of cryoablation of renal-cell carcinoma on nearby renal cysts with the goal to investigate the potential for an alternative therapy to treat symptomatic renal cysts. Materials and Methods The study population comprised 46 cysts (mean size, 12 mm; range, 5–43 mm) that were within or near the ice ball during cryoablation in 22 patients. Size change of each cyst was evaluated via enhanced CT or MR imaging before and 1, 3, 6, and 12 months after cryoablation. Forty-one cysts were also followed after 12 months. Variables including positional relationship between the cyst and the ice ball were evaluated via linear regression analysis using generalized estimating equation models to determine which factors affected cyst shrinkage rate at 12 months. Results Fifteen, 12, and 19 cysts were completely included in, partially included in, or excluded from the ice ball, respectively. The overall shrinkage rate was 62%, and 57% of cysts (26 of 46) had disappeared at 12 months. Only the relationship between the cyst and the ice ball was significantly (P <.001) associated with cyst shrinkage rate. Cyst disappearance rates at 12 months were 100% (15 of 15), 67% (8 of 12), and 16% (3 of 19) for cysts completely included, partially included, and excluded from the ice ball, respectively. Among the 22 cysts that disappeared at 12 months and continued to be followed, none recurred after 12 months. Conclusions All renal cysts that were completely included in the ice ball disappeared after cryoablation, demonstrating the potential utility of cryoablation as an alternative therapy for symptomatic renal cysts.

DOI： 10.1016/j.jvir.2017.02.027

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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：TAYLOR & FRANCIS LTD  

Purpose: To retrospectively evaluate the safety and diagnostic yield of needle biopsy of small renal tumors, and the clinical consequences of performing needle biopsy in patients referred for percutaneous cryoablation before their treatment. Material and methods: Biopsy was performed for 120 tumors (mean diameter, 2.2 cm) in 119 patients. All procedures were divided into diagnostic and non-diagnostic biopsies. Various variables were compared between the two groups. All cryoablation procedures were divided into two groups: procedures with or without simultaneous biopsy. The rates of benign or non-diagnostic tumors in each group were compared. Results: After performing 120 initial and eight repeat biopsies, Grade 1 bleedings occurred in 44 cases. Six tumors were non-diagnostic and 114 were pathologically diagnosed. There were no significant variables between the diagnostic and non-diagnostic biopsies. Unnecessary cryoablation was avoided in nine benign lesions by performing biopsy in advance. Cryoablation performed simultaneously with biopsy included significantly more benign or non-diagnostic tumors than cryoablation performed after biopsy (15.2% vs. 1.4%; p =.01). Conclusions: Percutaneous biopsy of small renal tumors referred for cryoablation was a safe procedure with high diagnostic yield. The confirmation of pathological diagnosis prior to cryoablation is necessary because patients with benign tumors can avoid unnecessary treatment.

DOI： 10.1080/13645706.2016.1249889

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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：SPRINGER  

Purpose: This retrospective, single-center study evaluated radiofrequency (RF) ablation for pulmonary metastases of sarcoma. Materials and methods: Forty-six patients with sarcoma (144 pulmonary metastases) underwent 88 RF ablation sessions. Data regarding local tumor progression, efficacy, procedural adverse events (AEs; National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0), overall survival (OS), and OS-associated prognostic factors were retrospectively evaluated using univariate analyses. Results: Local progression occurred in 22 of 144 tumors (15.3%). Primary and secondary efficacy rates were 83.5 and 90.0% at 1 year and 76.3 and 81.4% at 2 years, respectively. Seventy-three grade 1 AEs, 33 grade 2 AEs, and no grade ≥ 3 AEs were observed. Twenty-eight patients (60.9%) remained alive and 18 died, yielding 1-, 2-, and 3-year OS rates of 80.6, 70.1, and 47.1% (median survival time, 31.7 months). Univariate analysis revealed extrapulmonary metastasis (P = 0.005), noncurative RF ablation (P = 0.009), and a post-RF ablation disease-free interval of ≤12 months (P = 0.015) as significant negative prognostic factors. Conclusion: RF ablation is safe, offers good local control, and may be a viable treatment option for pulmonary metastasis of sarcoma.

DOI： 10.1007/s11604-016-0601-z

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掲載種別：研究論文（学術雑誌）   出版者・発行元：The Japanese Society of Interventional Radiology  

DOI： 10.22575/interventionalradiology.2017-0010

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掲載種別：研究論文（学術雑誌）   出版者・発行元：The Japanese Society of Interventional Radiology  

DOI： 10.22575/interventionalradiology.2017-0006

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掲載種別：研究論文（学術雑誌）   出版者・発行元：The Japanese Society of Interventional Radiology  

DOI： 10.22575/interventionalradiology.2.1_14

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記述言語：日本語   出版者・発行元：金原出版(株)  

57歳女。下肢腫瘍および歩行困難を主訴とした。切除不能な肝内胆管癌(cT3N0M0 stage III)の診断で化学療法を開始したが、18ヵ月後より下肢の腫脹と疼痛を自覚し、造影CTで胆管癌病変による下大静脈の高度狭窄を認めた。悪性下大静脈症候群の診断で放射線治療や薬物治療を行うも治療抵抗性であり、肝機能、心機能の評価も踏まえた上で、症状緩和を目的とした下大静脈ステント留置術の適応と判断した。消化管用ステントを用いて下大静脈ステント留置術を行ったところ、明らかな合併症を認めることなく下大静脈の狭窄と狭窄部の血流は改善し、側副路の描出減弱と静脈圧の圧較差減少が得られた。消化管用ステントはメッシュが細かく、屈曲に対して柔軟性があり、ステント移動は生じにくいと考えられた。本症例ではステント移動は認めず、良好な治療効果を得られた。

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記述言語：日本語   出版者・発行元：(一社)日本コンピュータ外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本コンピュータ外科学会  

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記述言語：日本語   出版者・発行元：(株)学研メディカル秀潤社  

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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：FUJI TECHNOLOGY PRESS LTD  

In recent years, a medical procedure called interventional radiology (IR) has been attracting considerable attention. Doctors can perform IR percutaneously while observing the fl roscopic image of patients. Therefore, this surgical method is less invasive. In this surgery, computed tomography (CT) equipment is often used for precise fl roscopy. However, doctors are exposed to strong radiation from the CT equipment. In order to overcome this problem, we have developed a remote-controlled surgical assistance robot called Zerobot. In animal puncture experiment, the operation of Zerobot was based on joint control. Therefore, during a surgery, the tip of the needle moves when a surgeon orders for a change in the direction of the needle. This makes the robot less user-friendly because the surgeon tracks the trajectory of the tip of the needle. This problem can be solved by using remote center control.

DOI： 10.20965/jrm.2016.p0911

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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：WICHTIG PUBLISHING  

Purpose: To evaluate retrospectively the fracture risk of totally implanted venous access devices connected to Groshong silicone (SC) versus polyurethane (PU) catheters, inserted via the internal jugular vein. Materials and methods: The study population comprised 384 SC and 221 PU central venous catheters implanted via the internal jugular vein. The presence of catheter fracture was evaluated. Variables possibly related to catheter fracture were evaluated. First, in order to determine the factors associated with fracture, fracture rates were compared with the log-rank test between the two groups divided by each of the variables. Then, in order to adjust for potential confounders, propensity-score matching of the variables was employed in the two catheter groups. Finally, the rates of fracture were compared between the two propensity-score-matched catheter groups. Results: There were 16 cases of catheter fracture, for an overall fracture percentage of 2.6% (16/605). All 16 cases of fracture occurred in the SC catheter group. Smaller patient body mass index (p = 0.039), deeper catheter tip position (p = 0.022), and SC catheters (p = 0.019) were significantly associated with fracture. With the propensity-score-matching method, 180 cases were selected in each catheter group. Comparison of the two propensity-score-matched groups showed that fracture rates for SC catheters remained significantly (p = 0.018) higher than those for PU catheters. Conclusions: Ports connected to Groshong SC catheters – when implanted via the internal jugular vein – posed a higher risk of fracture than did ports connected to PU catheters.

DOI： 10.5301/jva.5000606

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掲載種別：研究論文（学術雑誌）  

Objective: The goal of this study was to retrospectively evaluate the outcome, including feasibility, safety, diagnostic yield, and factors affecting the success of computed tomography fluoroscopy-guided biopsy when performed during the same procedure than radiofrequency ablation (RFA) in renal tumors strongly suspected of being T1a renal cell carcinoma (RCC). Materials and methods: Nineteen patients (13 men, 6 women; mean age, 66.7 years) with a total of 19 suspected renal tumors (mean diameter, 1.8cm) underwent computed tomography fluoroscopy-guided biopsy during (n=6) or immediately after (n=13) RFA. All patients were strongly suspected of having RCC on the basis of patient's medical histories and/or the results of imaging investigations. All procedures were divided into diagnostic and non-diagnostic biopsies. Various variables were compared between the 2 groups using univariate analysis. Results: In all tumors, biopsy procedures were technically feasible. No major complications were observed, except for 8 minor post-procedural bleedings. All but one tumor was completely ablated. Local recurrence in the ablation zone as well as tumor seeding in retroperitoneal fat occurred in 1 patient 8.5months after the procedure and were successfully treated with further percutaneous cryoablation. Thirteen tumors were diagnosed as RCC, whereas 6 were ultimately found to contain normal renal tissue (n=5) or connective tissue (n=1). Univariate analysis revealed that none of the variables were significantly different between the diagnostic and non-diagnostic biopsies. Conclusion: The performance of renal tumor biopsy and RFA in the same session is feasible and safe. Although pre-treatment pathological diagnosis would be generally desirable, simultaneous biopsy with RFA can be an option for the patients who are not amenable to pre-treatment biopsy.

DOI： 10.1016/j.diii.2016.05.001

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記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：IEEE  

Interventional radiology is a minimally invasive image-guided procedure. In the case of using computed tomography (CT) as an image-guidance for interventional radiology, the radiation exposure is a major problem to an operator who stands close to a CT gantry. To solve this problem, we are developing a remote-controlled puncturing robot which has five degrees of freedom. In this paper, we describe the details of the prototype robot and show experimental results to evaluate the robot's repeatability and a result of puncturing to a phantom.

DOI： 10.1109/ICIEA.2016.7603732

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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：ELSEVIER SCIENCE INC  

Purpose To conduct a retrospective evaluation of long-term survival after radiofrequency (RF) ablation for lung oligometastases from 5 types of primary lesions. Materials and Methods The study population consisted of 123 patients with lung oligometastases from colorectal cancer (CRC), non–small-cell lung cancer, hepatocellular carcinoma, esophageal cancer, and renal-cell carcinoma treated with RF ablation. Lung oligometastases were defined as 1–5 metastases confined to the lung while the primary cancer and other metastases were eradicated. Overall survival (OS) and recurrence-free survival (RFS) were estimated for the overall study population and for patients with each type of primary lesion. The OS and RFS rates were compared with those of the patients with any of the other four primary lesion types. Finally, various variables were analyzed to determine what factors influenced OS and RFS. Results The median follow-up was 45.7 months, and the 5-year OS and RFS rates for all 123 patients were 62% and 25%, respectively. The OS time for patients with metastases from CRC was significantly longer (P = .042); it was significantly shorter (P = .022) in patients with metastases from esophageal cancer. Longer disease-free interval was significantly (P = .015) associated with better OS. There was no variable significantly associated with OS and RFS on multivariate analyses. Conclusions Data from this single-center study appear promising in terms of long-term survival after RF ablation of lung oligometastases from 5 primary lesions.

DOI： 10.1016/j.jvir.2016.05.017

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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：LIPPINCOTT WILLIAMS & WILKINS  

Objective The aim of this study was to evaluate radiofrequency ablation (RFA) of lung tumors with dual-energy computed tomography while focusing on tumor composition and lung perfusion. Methods The 36 tumors in 25 patients were included. Dual-energy computed tomography was performed before RFA and at 2 days and 1, 3, and 6 months thereafter. The effective atomic number (Z eff) of the tumors before RFA was compared with the Z eff at each follow-up using the paired t test. Lung perfusion was evaluated by iodine map images. When decreased perfusion was suspected after RFA, lung perfusion scintigraphy was performed. Results The mean Z eff of the tumors significantly (P < 0.001) decreased at each follow-up, compared with that before RFA. Lung perfusion in the parenchyma peripheral to the tumors appeared to decrease at 2 days in 9 tumors, which was confirmed by scintigraphy in 7 tumors. Conclusions Dual-energy computed tomography was useful by providing additional information on tumor composition and lung perfusion.

DOI： 10.1097/RCT.0000000000000422

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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：SPRINGER  

Introduction: Computed tomography (CT) fluoroscopy-guided renal cryoablation and lung radiofrequency ablation (RFA) have received increasing attention as promising cancer therapies. Although radiation exposure of interventional radiologists during these procedures is an important concern, data on operator exposure are lacking. Materials and Methods: Radiation dose to interventional radiologists during CT fluoroscopy-guided renal cryoablation (n = 20) and lung RFA (n = 20) was measured prospectively in a clinical setting. Effective dose to the operator was calculated from the 1-cm dose equivalent measured on the neck outside the lead apron, and on the left chest inside the lead apron, using electronic dosimeters. Equivalent dose to the operator’s finger skin was measured using thermoluminescent dosimeter rings. Results: The mean (median) effective dose to the operator per procedure was 6.05 (4.52) μSv during renal cryoablation and 0.74 (0.55) μSv during lung RFA. The mean (median) equivalent dose to the operator’s finger skin per procedure was 2.1 (2.1) mSv during renal cryoablation, and 0.3 (0.3) mSv during lung RFA. Conclusion: Radiation dose to interventional radiologists during renal cryoablation and lung RFA were at an acceptable level, and in line with recommended dose limits for occupational radiation exposure.

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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：ELSEVIER SCIENCE INC  

Purpose To retrospectively investigate the impact of the electrode array diameter on local tumor progression after lung radiofrequency ablation. Materials and Methods This study included 651 lung tumors treated using multitined expandable electrodes and followed for 6 months. The mean long-axis tumor diameter was 12 mm ± 7 (range, 2-42 mm). The difference between electrode array diameter and tumor diameter (DAT) was used to investigate the impact of the electrode array diameter. All tumors were classified into 2 groups according to various variables including DAT (10 mm or < 10 mm). The primary technique efficacy rates were calculated using Kaplan-Meier analysis and compared between the 2 groups of each variable using the log-rank test. In addition, crude and multivariate multilevel survival analyses were performed by sequentially including DAT and the other variables in 5 models. Results The median DAT for 651 tumors was 12 mm (range, -15 to 24 mm). The technique efficacy rate was significantly lower in the < 10 mm DAT group than in the 10 mm group (P <.001). In the crude and multivariate multilevel survival analyses, < 10 mm DAT was a significant risk factor for local progression in all models except model 5 (P =.067). In the 10 mm group, the technique efficacy rates were not significantly different between the 2 10 mm DAT subgroups (10 to <15 mm DAT vs 15 mm DAT). Conclusions DAT is an important risk factor for local progression. We recommend an electrode that is 10 mm larger than the tumor diameter.

DOI： 10.1016/j.jvir.2015.07.025

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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：SPRINGER  

Objectives: To retrospectively evaluate the safety of computed tomography (CT) fluoroscopy-guided short hook wire placement for video-assisted thoracoscopic surgery and the risk factors for pneumothorax associated with this procedure. Methods: We analyzed 267 short hook wire placements for 267 pulmonary lesions (mean diameter, 9.9 mm). Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for pneumothorax. Results: Complications (219 grade 1 and 4 grade 2 adverse events) occurred in 196 procedures. No grade 3 or above adverse events were observed. Univariate analysis revealed increased vital capacity (odds ratio [OR], 1.518; P = 0.021), lower lobe lesion (OR, 2.343; P = 0.001), solid lesion (OR, 1.845; P = 0.014), prone positioning (OR, 1.793; P = 0.021), transfissural approach (OR, 11.941; P = 0.017), and longer procedure time (OR, 1.036; P = 0.038) were significant predictors of pneumothorax. Multivariate analysis revealed only the transfissural approach (OR, 12.171; P = 0.018) and a longer procedure time (OR, 1.048; P = 0.012) as significant independent predictors. Conclusion: Complications related to CT fluoroscopy-guided preoperative short hook wire placement often occurred, but all complications were minor. A transfissural approach and longer procedure time were significant independent predictors of pneumothorax. Key Points: • Complications related to CT fluoroscopy-guided preoperative short hook wire placement often occur. • Complications are usually minor and asymptomatic. • A transfissural approach and longer procedure time are significant independent predictors of pneumothorax.

DOI： 10.1007/s00330-015-3815-z

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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：OKAYAMA UNIV MED SCHOOL  

An 87-year-old Japanese man underwent percutaneous cryoablation (PCA) therapy for his renal cell tumor. We displaced the colon from the tumor using hydrodissection. Computed tomography (CT) immediately after PCA was indicative of iceball extension to the colon wall, and a discontinuous enhancement of the colon wall was observed. We therefore performed an emergency surgery. On laparotomy, we observed a dark-purple area on the affected area of the colon, and the resected specimen showed focal, deep ulceration on the mucosal surface. Photomicrography revealed mucosal necrosis, submucosal hemorrhage, and necrotic foci in the muscularis propria, corresponding to the discontinuous colon wall enhancement on CT and the deep ulceration and dark-purple area on laparotomy. He recovered from surgery and was discharged without any complications.

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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：JAPAN SOC INTERNAL MEDICINE  

A 68-year-old woman was scheduled to undergo percutaneous embolization of a pulmonary arteriovenous malformation (PAVM) to prevent a paradoxical embolic event. After contrast-enhanced computed tomography (CT) was performed to carefully evaluate the PAVM, she developed acute interstitial nephritis, which required steroid therapy. Moreover, her D-dimer level increased, which was suggestive of thrombus formation. After nine months, we noted that the affected vessels had markedly decreased in size, and the fistula had almost disappeared on unenhanced CT images. To our knowledge, this is the first case report to describe the regression of a PAVM, detected by CT, after the onset of acute interstitial nephritis.

DOI： 10.2169/internalmedicine.55.5445

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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：OKAYAMA UNIV MED SCHOOL  

This single center prospective study is being conducted to evaluate the safety of the cryoablation for patients with pathologically diagnosed painful bone and soft tissue tumors. Enrollment of 10 patients is planned over the 3-year recruitment period. Patients have related local pain after receiving medications or external radiation therapies will be included in this study. Cryoablation will be percutaneously performed under imaging guidance, and a temperature sensor will be used during treatment as necessary. The primary endpoint is prevalence of severe adverse events within 4 weeks after therapy. The secondary endpoint is effectiveness 4 weeks after the procedure.

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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：OKAYAMA UNIV MED SCHOOL  

The present single center prospective phase II clinical trial is designed to evaluate the efficacy and safety of percutaneous radiofrequency (RF) ablation for colorectal lung metastases. Patients who have colorectal lung metastases without extrapulmonary metastases are included in this study. The primary endpoint is 3-year overall survival (OS) after RF ablation. The secondary endpoints are the prevalence of adverse events within 4 weeks, local tumor progression rate, 1- and 5-year OS, cause-specific survival, and relapse-free survival. The recruitment of patients commenced in July 2014, and the enrolment of 45 patients is intended over the 3 years of study period.

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記述言語：日本語   出版者・発行元：金原出版(株)  

症例は30歳代男性で、5年前にネパールから来日した。1週間前から白濁尿と全身倦怠感が出現した。尿から脂肪成分を検出し、乳び尿と診断した。臨床像からフィラリア症の可能性を疑い、夜間に血液検体を採取したところ、血液塗抹標本にてフィラリア虫体を確認した。さらに、遺伝子解析によりバンクロフト糸状虫症によるフィラリア性乳び尿と確定診断した。抗フィラリア薬であるジエチルカルバマジンクエン酸塩およびドキシサイクリン塩酸塩水和物の内服療法を行い、末梢血中のミクロフィラリアが消失したことを確認した。また乳び尿も消失したが、治療後1年で乳び尿の再燃を認めた。リンパ管造影検査後3日間程度は乳び尿の消失を認めたが、その後乳び病の再燃を認めた。高脂血症用剤のエゼチミブ内服で経過観察となったが、効果は不十分であった。フィラリア症再燃の可能性を疑い、ジエチルカルバマジンを再開したところ、乳び尿も改善した。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J01565&link_issn=&doc_id=20161004110012&doc_link_id=10.18888%2FJ01565.2017017045&url=https%3A%2F%2Fdoi.org%2F10.18888%2FJ01565.2017017045&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

掲載種別：研究論文（学術雑誌）   出版者・発行元：The Japanese Society of Interventional Radiology  

DOI： 10.22575/interventionalradiology.1.1_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：SPRINGER  

Purpose: The aim of the study was to retrospectively evaluate simultaneous multiple hook wire placement outcomes before video-assisted thoracoscopic surgery (VATS). Materials and Methods: Thirty-eight procedures were performed on 35 patients (13 men and 22 women; mean age, 59.9 years) with 80 lung lesions (mean diameter 7.9 mm) who underwent simultaneous multiple hook wire placements for preoperative localizations. The primary endpoints were technical success, complications, procedure duration, and VATS outcome; secondary endpoints included comparisons between technical success rates, complication rates, and procedure durations of the 238 single-placement procedures performed. Complications were also evaluated. Results: In 35 procedures including 74 lesions, multiple hook wire placements were technically successful; in the remaining three procedures, the second target placement was aborted because of massive pneumothorax after the first placement. Although complications occurred in 34 procedures, no grade 3 or above adverse event was observed. The mean procedure duration was 36.4 ± 11.8 min. Three hook wires dislodged during patient transport to the surgical suite. Seventy-four successfully marked lesions were resected. Six lesions without hook wires were successfully resected after detection by palpation with an additional mini-thoracotomy or using subtle pleural changes as a guide. The complication rates and procedure durations of multiple-placement procedures were significantly higher (P = 0.04) and longer (P < 0.001) than those in the single-placement group, respectively, while the technical success rate was not significantly different (P = 0.051). Conclusions: Simultaneous multiple hook wire placements before VATS were clinically feasible, but increased the complication rate and lengthened the procedure time.

DOI： 10.1007/s00270-014-1028-5

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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：ELSEVIER SCIENCE INC  

Purpose To retrospectively evaluate radiofrequency (RF) ablation of lung tumors performed via the transosseous approach. Materials and Methods Twelve lung tumors (mean diameter, 1.0 cm; range, 0.4-1.6 cm) in 12 patients were treated by RF ablation via a transscapular and/or transrib route with the use of a bone biopsy needle under computed tomographic fluoroscopy guidance. Therapeutic outcomes evaluated included feasibility, safety, and local efficacy. Complications were assessed based on the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. Results The transosseous route was successfully employed in all patients, and the electrode was successfully advanced into all tumors with this approach. The mean distance of penetrated bone was 0.57 cm (range, 0.19-1.16 cm). Complications occurred in eight RF ablation sessions, including six grade 1 events (two cases of pneumothorax and one case each of asymptomatic rib fracture 6 mo after treatment, neuralgia, pulmonary hemorrhage, and hemothorax), two grade 2 events (pneumonia and high fever), and one grade 3 event (pneumothorax requiring pleurodesis). No adverse events of grade ≥ 4 occurred. The mean and median tumor follow-up periods were 19.5 and 15.2 mo (range, 3.0-41.5 mo). Local progression occurred in two cases at 3 and 12 mo after treatment and was successfully treated with a second RF ablation procedure. The technique efficacy rates were 91.7% at 6 mo, 81.5% at 1 y, and 81.5% at 2 y. Conclusions The transosseous approach was feasible in computed tomographic fluoroscopy-guided RF ablation of select lung tumors when no other option was available.

DOI： 10.1016/j.jvir.2015.08.012

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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：ELSEVIER IRELAND LTD  

Purpose To prospectively investigate the incidence of post-lung radiofrequency (RF) ablation fever as well as its associated factors, according to the grade of fever. Materials and Methods A total of 56 patients who underwent 67 lung RF sessions were analyzed. Post-ablation fever (≥37.0 °C) was graded according to the common toxicity criteria of adverse events v. 4.0. Fever ≥37.0 °C and <38.0 °C was defined as grade 0 fever. The 67 RF sessions were divided into two groups according to the presence of post-ablation fever, and the factors associated with fever were determined using univariate and multivariate analyses. Subsequently, the RF sessions accompanied by post-ablation fever were further divided into two groups according to the grade of fever (grade 0 vs. grade ≥1), and the factors associated with the grade of fever were determined. Results Grade 0, 1, and 2 fever accompanied 36 (54%), 11 (16%), and 2 (3%) sessions, respectively. Post-ablation fever was significantly associated with larger ablated parenchymal volume (P = 0.001) and development of pulmonary infiltration (P = 0.004). Additionally, development of pulmonary infiltration (P = 0.048) was also significantly and independently associated with higher grade of fever in the multivariate analysis. Conclusions The incidences of grade 0, 1, and 2 post-ablation fever were 54%, 16%, and 3%, respectively. Larger ablated parenchymal volume and development of pulmonary infiltration were found to be associated with the development of post-ablation fever, with the latter being an independent factor associated with higher grade of fever.

DOI： 10.1016/j.ejrad.2015.07.009

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記述言語：英語   出版者・発行元：SPRINGER  

DOI： 10.1007/s00270-015-1076-5

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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：SPRINGER  

DOI： 10.1007/s00270-015-1122-3

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記述言語：日本語   出版者・発行元：中国・四国整形外科学会  

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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：SPRINGER  

Purpose: To evaluate the feasibility and safety of transcatheter arterial embolization (TAE) with the use of HepaSphere microspheres for hypervascular tumors. Materials and methods: This was a prospective multicenter open label clinical trial involving six institutions in Japan. TAE was performed with the HepaSphere microspheres for hypervascular tumors in various locations. The endpoint of the study was the feasibility and safety of the procedure. The feasibility and safety were evaluated according to technical success and adverse events, respectively. Adverse events that were related to TAE were evaluated by using the Common Terminology Criteria for Adverse Events, version 4.0. Results: Twenty-four patients were enrolled. The technical success rate was 100 % (24/24). Twenty-two (92 %) patients developed a total of 50 symptomatic adverse events, including 30 grade 1 events, 17 grade 2 events, and 3 grade 3 events. The most frequent adverse event was fever with an incidence of 63 %, followed by abdominal pain (25 %). Conclusion: TAE for hypervascular tumors with the HepaSphere microspheres was feasible and rarely caused major adverse events. Trial registration: This trial was registered in JAPIC Clinical Trials Information (JapicCTI-111534).

DOI： 10.1007/s11604-015-0448-8

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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：JAPAN SOC INTERNAL MEDICINE  

Hepatic intracystic hemorrhage is a rare complication of polycystic liver diseases, such as autosomal dominant polycystic kidney disease (ADPKD). A hepatic cyst with mural nodules and septation may suggest the presence of a cystic malignancy, such as biliary cystadenocarcinoma. We herein report a case of hepatic intracystic hematoma with a mural nodule mimicking biliary cystadenocarcinoma in a patient with ADPKD. Hepatic intracystic hemorrhage with a mural nodule is a very rare occurrence. A fat-saturated T1-weighted magnetic resonance image may be useful for making an accurate diagnosis of intracystic hematoma.

DOI： 10.2169/internalmedicine.54.4218

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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：ELSEVIER SCIENCE INC  

DOI： 10.1016/j.jvir.2015.01.030

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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：ELSEVIER SCIENCE INC  

Purpose To retrospectively evaluate the outcomes of radiofrequency (RF) ablation of lung metastases from head and neck adenoid cystic carcinoma (ACC). Materials and Methods Nine patients (two men and seven women; mean age, 61.6 y) with 45 lung metastases (mean diameter, 1.1 cm; range, 0.4-2.7 cm) from head and neck ACC underwent RF ablation in 30 sessions. Primary endpoints were technical success, technique effectiveness, and procedural complications. Secondary endpoints included overall survival (OS). Results RF ablation was technically successful for all 45 metastases. The median tumor follow-up period was 37.1 months (range, 12.9-128.3 mo). Local progression occurred in six tumors, two of which were treated again and subsequently showed complete response. Major complications (pneumothorax requiring chest tube placement) occurred in five sessions (16.7%). The median patient follow-up period was 61.6 months (range, 20.5-134.5 mo). Two patients died of disease progression at 38.9 and 61.6 months after RF ablation, respectively, whereas the other seven remained alive at the end of the study. OS rates from the initial RF ablation were 100% at 3 years and 83.3% at 5 years (mean survival time, 106.4 mo). OS rates from the treatment of the primary site were 100% at 5 years and 62.5% at 10 years (mean survival time, 210.1 mo). Conclusions Radiofrequency ablation is an acceptable and effective local treatment for lung metastases from head and neck ACC. However, further study is needed to evaluate its effect on patient survival.

DOI： 10.1016/j.jvir.2014.11.040

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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：SPRINGER  

There has been an increasing demand for interventional radiology (IR) procedures for the treatment of severe postpartum hemorrhage (PPH) (also called critical hemorrhage in obstetrics). The Japanese Society of Interventional Radiology Guideline Committee developed the practical guidelines for IR procedures for severe PPH using evidence-based methodology. This article aimed to describe the rationale for developing these guidelines and to provide the answers for clinical questions about IR procedures consisting of current available evidence and the consensus among experts.

DOI： 10.1007/s11604-015-0399-0

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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：SPRINGER  

Purpose: We retrospectively evaluated the outcomes of lung cancer patients presenting with ground-glass opacity (GGO) who received radiofrequency ablation (RFA).Methods: Sixteen patients (5 men and 11 women; mean age, 72.6 years) with 17 lung cancer lesions showing GGO (mean long axis diameter, 1.6 cm) underwent a total of 20 percutaneous computed tomography (CT) fluoroscopy-guided RFA sessions, including three repeated sessions for local progression. Lung cancer with GGO was defined as a histologically confirmed malignant pulmonary lesion with a GGO component accounting for >50 % of the lesion on high-resolution CT. Procedure outcomes were evaluated.Results: There were no major complications. Pneumothorax occurred in 15 of 20 treatment sessions: 14 were asymptomatic, and 1 required chest tube placement but resolved satisfactorily within 48 h. Minor pulmonary hemorrhage occurred in two and mild pneumonitis in one. The median tumor follow-up period was 61.5 (range 6.1–96.6) months. The effectiveness rates of the primary and secondary techniques were 100 and 100 % at 1 year, 93.3 and 100 % at 2 years, and 78.3 and 92.3 % at 3 years, respectively. The median patient follow-up period was 65.6 (range 6.1–96.6) months. One patient died owing to recurrent other cancer 11.7 months after RFA, whereas the other 15 remained alive. Overall survival and disease-specific survival rates were 93.3 and 100 % at 1 year and 93.3 and 100 % at 5 years, respectively.Conclusions: RFA for lung cancer with GGO was safe and effective, and resulted in promising survival rates.

DOI： 10.1007/s00270-014-0926-x

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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：SAGE PUBLICATIONS LTD  

A 63-year-old man with metastatic castration-resistant prostate cancer (CRPC) was successfully treated for two years with in situ gene therapy using an adenovirus vector carrying the human REIC/Dkk‑3 gene (Ad-REIC), following chemotherapy. Ad-REIC mediates simultaneous induc-tion of cancer-selective apoptosis and augmentation of antitumor immunity, and a Phase I/IIa clinical study on Ad-REIC has been conducted at Okayama University Hospital since January 2011. At the time of enrollment in December 2012, the patient presented with rapid progression of lymph node (LN) metastases. Two scheduled Ad-REIC injections and 10 additional Ad-REIC injections into metastatic pelvic and para-aortic LNs under CT guidance, with an average four weeks’ interval, exhibited the potent direct and indirect effects of Ad-REIC as a therapeutic cancer vaccine. During the next 12 months, three additional injections into para-aortic LNs showing regrowth achieved adequate control of all metastatic LNs with prostate-specific antigen (PSA) decline, without any particular adverse events.

DOI： 10.4137/CMO.S23252

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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：SPRINGER  

Purpose: We retrospectively evaluated the results of the transfissural route for preoperative localization with a short hook wire and suture system for video-assisted thoracoscopic surgery (VATS). Methods: Eleven patients with 11 tumors underwent CT-guided transfissural placement of a hook wire before VATS. This route was selected for all patients, because the distance between the tumor and interlobar fissure was much shorter than the required distance traversed using the conventional approach. Complications were evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0. Results: The hook wire was successfully placed using the transfissural route in all but one case. Of these ten successful placements, two tumors needed a second puncture for optimal placement, because the CT scan showed that the first hook wire was not properly placed in the lung. In one patient, we did not attempt replacement after the first placement was incorrect. In ten successful procedures, the mean distance traversed in the parenchyma of the unaffected lung lobe was 27.9 mm. The distance between the pleura and placed hook wire was significantly shorter than the estimated distance between the pleura and hook wire using the conventional route (mean 16.3 vs. 40.9 mm; P = 0.0002). Grade 1 adverse events occurred (11 pneumothoraxes and 4 pulmonary hemorrhages). No grade 2 or higher adverse event was observed. Conclusions: The transfissural route used for preoperative localization before VATS is useful for selected patients because this route may allow for more limited lung parenchyma resection.

DOI： 10.1007/s00270-014-0862-9

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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：ELSEVIER SCIENCE INC  

Purpose: To retrospectively evaluate long-term survival outcomes of radiofrequency (RF) ablation of colorectal lung metastases and evaluate factors associated with improved survival. Materials and Methods: Eighty-four patients (46 male and 38 female; median age, 65 y) with 172 colorectal lung metastases (median size, 1.2 cm) underwent 113 RF ablation sessions. Thirteen patients had viable extrapulmonary recurrences at the time of RF ablation. The primary endpoint was patient survival. Prognostic factors associated with survival were determined by univariate and multivariate analyses. Secondary endpoints were local tumor progression and adverse events (per National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0). Results: During follow-up (median duration, 37.5 mo), 36 patients (42.9%) died. The estimated overall survival (OS) rates were 95.2%, 65.0%, and 51.6% at 1, 3, and 5 years, respectively (median OS time, 67.0 mo). Multivariate analysis revealed that a carcinoembryonic antigen (CEA) level of at least 5 ng/mL before RF ablation (P = .03) and the presence of viable extrapulmonary recurrences at the time of RF ablation (P = .001) were independent negative prognostic factors. The local tumor progression rate was 14.0% (24 of 172 tumors). Grade 3 adverse events were observed after two sessions (1.8%), and grade 4/5 adverse events were not observed. Conclusions: RF ablation of colorectal lung metastases provided favorable long-term survival with a low incidence of severe adverse events. Independent prognostic factors were a high CEA level before RF ablation and the presence of viable extrapulmonary recurrences at the time of RF ablation.& SIR, 2015.

DOI： 10.1016/j.jvir.2014.11.013

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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：OKAYAMA UNIV MED SCHOOL  

A case of advanced rectal cancer treated by aggressive local and systemic treatment who has survived more than 7 years from initial recurrence is presented. A 55-year-old woman was diagnosed with advanced lower rectal cancer and underwent a low anterior resection with complete removal of all regional lymph nodes and total mesorectal excision. The tumor was diagnosed as a moderately differentiated adenocarcinoma, pStage IIIB (T3, N2a, M0). Twenty-six months after the initial surgery, local recurrence in the pelvis was detected by computed tomography, and total pelvic exenteration with distal sacrectomy (TPES) was performed after systemic chemotherapy with a molecular-targeted drug. Six months after the TPES, multiple lung metastases were detected. Consequently, the patient underwent radiofrequency ablation (RFA) and chemotherapy. The disease has since been controlled for 38 months. As volume control is essential for cancer treatment, it may be important to combine appropriate local therapy with systemic therapy to metastatic or recurrent sites in order to achieve much longer disease control.

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：日本語   出版者・発行元：(株)学研メディカル秀潤社  

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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：ELSEVIER SCIENCE INC  

Purpose To evaluate retrospectively outcomes after radiofrequency (RF) ablation for pulmonary metastases from esophageal cancer.

DOI： 10.1016/j.jvir.2014.06.030

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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：SPRINGER  

Purpose: To determine risk factors for systemic air embolism by percutaneous computed tomography (CT)-guided lung biopsy.

DOI： 10.1007/s00270-013-0808-7

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(NPO)日本肺癌学会  

目的. 肺悪性腫瘍に対する経皮的CTガイド下ラジオ波焼灼療法は、2000年に開始された新たな局所治療である。本治療のI期非小細胞肺癌への有効性について検討する。また、本治療の原理、特殊性、適応、治療の実際などについて俯瞰的にまとめる。研究計画. 我々の施設におけるI期非小細胞肺癌50例52腫瘍(IA38例、IB12例)について後方視的に検討し、同治療の世界的な成績についてもまとめた。結果. 経過観察期間中央値は37ヵ月であった。腫瘍の局所再発率は31%(16/52)であった。全生存率、疾患特異的生存率ならびに無疾患生存率は、各々1年で94%、100%ならびに82%、2年で86%、93%ならびに64%、3年で74%、80%ならびに53%であった。治療はすべて局所麻酔下で行われ、入院期間も短く、副作用も少ないため、優れた低侵襲治療といえるが、一方では2cmを超える腫瘍では再発率が高いことが示されている。結論. 現在までに十分なランダム化比較試験は報告されておらず、後ろ向きコーホート研究のデータを主体にその治療成績に言及せざるを得ない状況にあるが、ラジオ波焼灼療法が施行された多くの患者は、様々な理由で手術ができない背景を抱えており、そのような患者については手術の代替治療になり得る可能性があると思われる。(著者抄録)

DOI： 10.2482/haigan.54.848

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J01244&link_issn=&doc_id=20150512320017&doc_link_id=%2Fec7jaluc%2F2014%2F005406%2F017%2F0848-0853%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fec7jaluc%2F2014%2F005406%2F017%2F0848-0853%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   出版者・発行元：NATURE PUBLISHING GROUP  

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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：SPRINGER  

Purpose: To investigate an association between reperfusion and the percentage of shrinkage of the aneurysmal sac after embolization of pulmonary arteriovenous malformation (PAVM) and to determine the cutoff value of the shrinkage percentage for indicating reperfusion. Materials and methods: Twenty-two PAVMs with completely embolized feeding arteries with coils were examined. The percentage of sac shrinkage and the presence of reperfusion were evaluated on computed tomography before and 1, 3, and 12 months after embolization. The percentages of sac shrinkage were compared between the occlusion and reperfusion groups. The receiver-operating characteristic (ROC) curve was generated to determine the diagnostic efficiency of reperfusion of PAVM by using shrinkage percentages. Results: Reperfusion was seen in 14, 13, and 11 lesions at 1, 3, and 12 months, respectively. The mean percentage of sac shrinkage was significantly different between the two groups at 3 and 12 months. The area under the ROC curve was 0.991 at 3 months and 0.934 at 12 months. All 9 lesions with <60 % sac shrinkage at 12 months showed reperfusion. Conclusion: The percentage of sac shrinkage was closely associated with reperfusion after embolization of PAVMs at 3 and 12 months. A shrinkage percentage of <60 % at 12 months indicated reperfusion. © 2014 Japan Radiological Society.

DOI： 10.1007/s11604-014-0301-5

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担当区分：筆頭著者,　責任著者   記述言語：英語   出版者・発行元：SPRINGER  

DOI： 10.1007/s00270-013-0736-6

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記述言語：英語   出版者・発行元：SPRINGER  

DOI： 10.1007/s00270-013-0753-5

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記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：IEEE  

There is a surgical method called Interventional Radiology (IVR) as one of lung cancer treatments. It has a problem that doctors are exposed to radiation because IVR is conducted in CT apparatus. In order to avoid the problem, a robotic IVR system that doctors conduct the puncture with a robot is developed. An operation test is necessary to develop the robotic IVR system, however, an experiment with real patients is rejected based on ethic regulation. Therefore, a phantom is used for experiments instead of patients. A phantom is a model of human used for both evaluation and adjustment of medical imaging equipments such as CT and MRI. However, ready-made phantoms can not be punctured, because they are only aimed to radiography and their surface are hard. Therefore a phantom for CT-IVR which can be punctured is developed.

DOI： 10.1109/SII.2014.7028016

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BAISHIDENG PUBL GRP CO LTD  

Radiofrequency ablation (RFA) causes focal coagulation necrosis in tissue. Its first clinical application was reported in 2000, and RFA has since been commonly used in both primary and metastatic lung cancer. The procedure is typically performed using computed tomography guidance, and the techniques for introducing the electrode to the tumor are simple and resemble those used in percutaneous lung biopsy. The most common complication is pneumothorax, which occurs in up to 50% of procedures; chest tube placement for pneumothorax is required in up to 25% of procedures. Other severe complications, such as pleural effusion requiring chest tube placement, infection, and nerve injury, are rare. The local efficacy depends on tumor size, and local progression after RFA is not rare, occurring in 10% or more of patients. The local progression rate is particularly high for tumors > 3 cm. Repeat RFA may be used to treat local progression. Short- to mid-term survival after RFA appears promising and is approximately 85%-95% at 1 year and 45%-55% at 3 years. Long-term survival data are sparse. Better survival may be expected for patients with small metastasis, low carcinoembryonic antigen levels, and/or no extrapulmonary metastasis. The notable advantages of RFA are that it is simple and minimally invasive; preserves pulmonary function; can be repeated; and is applicable regardless of previous treatments. Its most substantial limitation is limited local efficacy. Although surgery is still the method of choice for treatment with curative intent, the ultimate application of RFA may be to replace metastasectomy for small metastases. Randomized trials comparing RFA with surgery are needed. © 2014 Baishideng Publishing Group Co., Limited. All rights reserved.

DOI： 10.3748/wjg.v20.i4.988

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記述言語：日本語   出版者・発行元：金原出版(株)  

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：金原出版(株)  

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担当区分：筆頭著者,　責任著者   記述言語：英語   出版者・発行元：HINDAWI LTD  

This review examines studies of radiofrequency ablation (RFA) of nonsmall cell lung cancer (NSCLC) and discusses the role of RFA in treatment of early-stage NSCLC. RFA is usually performed under local anesthesia with computed tomography guidance. RFA-associated mortality, while being rare, can result from pulmonary events. RFA causes pneumothorax in up to 63% of cases, although pneumothorax requiring chest drainage occurs in less than 15% of procedures. Other severe complications are rare. After RFA of stage I NSCLC, 31-42% of patients show local progression. The 1-, 2-, 3-, and 5-year overall survival rates after RFA of stage I NSCLC were 78% to 100%, 53% to 86%, 36% to 88%, and 25% to 61%, respectively. The median survival time ranged from 29 to 67 months. The 1-, 2-, and 3-year cancer-specific survival rates after RFA of stage I NSCLC were 89% to 100%, 92% to 93%, and 59% to 88%, respectively. RFA has a higher local failure rate than sublobar resection and stereotactic body radiation therapy (SBRT). Therefore, RFA may currently be reserved for early-stage NSCLC patients who are unfit for sublobar resection or SBRT. Various technologies are being developed to improve clinical outcomes of RFA for early-stage NSCLC. © 2014 Takao Hiraki et al.

DOI： 10.1155/2014/152087

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担当区分：筆頭著者,　責任著者   記述言語：英語   出版者・発行元：ELSEVIER SCIENCE INC  

DOI： 10.1016/j.jvir.2014.03.035

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：日本語   出版者・発行元：(一社)日本インターベンショナルラジオロジー学会  

CT透視システムは、血管内治療のガイディングツールとして極めて有用である。しかし、術者はCTガントリーの近くで手技を行うため、CT透視を用いている間に被曝する。術者が遠隔操作するロボットで針穿刺を行えば、術者の被曝は避けることができる。著者らは、術者の被曝ゼロを実現する遠隔操作可能なCT透視ガイド下針穿刺用のロボットの開発を行っている。これまでのロボット開発の歩みと今後の展望について述べた。

DOI： 10.11407/ivr.29.375

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J02793&link_issn=&doc_id=20141229330006&doc_link_id=10.11407%2Fivr.29.375&url=https%3A%2F%2Fdoi.org%2F10.11407%2Fivr.29.375&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

担当区分：筆頭著者   記述言語：日本語   出版者・発行元：金原出版(株)  

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記述言語：英語   出版者・発行元：ELSEVIER SCIENCE INC  

DOI： 10.1016/j.jvir.2013.03.023

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担当区分：最終著者   記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：IEEE  

There are surgical methods called Interventional Radiology (IVR) using CT equipments in medical treatments of lung cancers, a blood vessels, and so on. IVR has an advantage that invasiveness is low and medical treatments with local anesthesia are possible as compare with the fact that laparotomy surgeries require general one. Therefore the number of IVR surgery has been increasing in recent years. However, radiation exposure to doctors has been concerned in the current IVR, since medical doctors conduct the treatment using CT equipment. Thus, the IVR robot should be developed in order to avoid the radioactive exposure to doctors. In this research, a robot using a parallel link mechanism is developed from the viewpoints that hand accuracy and hand rigidity are high and motors can be arranged far from CT scanning plane. The dual delta-type parallel link is proposed. It has the structure which is arranged the delta-type parallel link mechanism with three degrees of freedom (DOF). First, the arm which has offset of the axis in consideration of interference was designed. Secondly, inverse kinematics of parallel link was analyzed. Next, Delta-type parallel link mechanism with three DOF was manufactured. Finally, basic motion of parallel link robot was confirmed.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1155/2013/438236

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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：OKAYAMA UNIV MED SCHOOL  

We retrospectively evaluated the accumulation of fluorodeoxy glucose (FDG) in pulmonary malignancies without local recurrence during 2-year follow-up on positron emission tomography (PET)/com-puted tomography (CT) after radiofrequency ablation (RFA). Thirty tumors in 25 patients were studied (10 non-small cell lung cancers; 20 pulmonary metastatic tumors). PET/CT was performed before RFA, 3 months after RFA, and 6 months after RFA. We assessed the FDG accumulation with the maximum standardized uptake value (SUVmax) compared with the diameters of the lesions. The SUVmax had a decreasing tendency in the first 6 months and, at 6 months post-ablation, FDG accumulation was less affected by inflammatory changes than at 3 months post-RFA. The diameter of the ablated lesion exceeded that of the initial tumor at 3 months post-RFA and shrank to pre-ablation dimensions by 6 months post-RFA. SUVmax was more reliable than the size measurements by CT in the first 6 months after RFA, and PET/CT at 6 months post-RFA may be more appropriate for the assessment of FDG accumulation than that at 3 months post-RFA. © 2013 by Okayama University Medical School.

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：THIEME MEDICAL PUBL INC  

Although radiofrequency ablation for lung cancer is generally safe (with a mortality rate <1%), it may cause various complications. Common complications include pneumothorax, pleural effusion, and parenchymal hemorrhage. Although most complications can be treated conservatively or with minimal therapy, physicians should be aware of rare but serious complications. Potentially fatal complications include massive hemorrhage, intractable pneumothorax due to bronchopleural fistula, pulmonary artery pseudoaneurysm, systemic air embolism, and pneumonitis. Other serious complications include injury to the nearby tissues (e.g., brachial nerve plexus, phrenic nerve, diaphragm, and chest wall), needle tract seeding, lung abscess, empyema, and skin burn. Although cavitation of the ablation zone is usually insignificant clinically, such a cavity occasionally ruptures, leading to pneumothorax and bleeding. Cavities may also serve as a scaffold for fungal colonization. Precautions to minimize risk should be taken whenever possible. Nevertheless, serious complications may occur, and thus physicians should be aware of the appropriate treatments for these complications. This article reviews complications associated with lung cancer ablation. © 2013 by Thieme Medical Publishers, Inc.

DOI： 10.1055/s-0033-1342958

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記述言語：日本語   出版者・発行元：(一社)日本インターベンショナルラジオロジー学会  

DOI： 10.11407/ivr.28.87

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記述言語：日本語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：(一社)日本腎臓学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J01126&link_issn=&doc_id=20130612290015&doc_link_id=10031177243&url=http%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F10031177243&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：日本語   出版者・発行元：(一社)日本インターベンショナルラジオロジー学会  

Irreversible electroporation (IRE) is emerging as a new minimally invasive ablation technique for the treatment of a variety of malignant tumors, which has unique aspects that differ from those of conventional ablation therapies such as radiofrequency ablation or cryotherapy. Electroporation means the formation of nanoscale pores in the cell membrane when certain electric fields are applied across the cell. This phenomenon can be reversible or irreversible according to the strength of the electric field. This non-thermal ablation provides entire tumor cell death preserving the surrounding important structures, such as vessels, bile ducts, and nerves. Tissue regeneration speed after the treatment is considerably faster than that of other ablation techniques. IRE could have potential advantages compared with thermal ablative modalities. Various tumors including liver cancer, pancreatic cancer, lung cancer, prostatic cancer and so on may be included in the application. Short-term treatment outcome is satisfactory and continued exploration is needed in human tumors.

DOI： 10.11407/ivr.28.172

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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：SPRINGER  

Purpose The purpose of this study was to evaluate altered pulmonary function retrospectively after RFA. Methods This retrospective study comprised 41 ablation sessions for 39 patients (22 men and 17 women; mean age, 64.8 years). Vital capacity (VC) and forced expiratory volume in 1 s (FEV 1) at 1 and 3 months after RFA were compared with the baseline (i.e., values before RFA). To evaluate the factors that influenced impaired pulmonary function, univariate analysis was performed by using multiple variables. If two or more variables were indicated as statistically significant by univariate analysis, these variables were subjected to multivariate analysis to identify independent factors. Results The mean VC and FEV1 before RFA and 1 and 3 months after RFA were 3.04 and 2.24 l, 2.79 and 2.11 l, and 2.85 and 2.13 l, respectively. The values at 1 and 3 months were significantly lower than the baseline. Severe pleuritis after RFA was identified as the independent factor influencing impaired VC at 1 month (P = 0.003). For impaired FEV1 at 1 month, only severe pleuritis (P = 0.01) was statistically significant by univariate analysis. At 3 months, severe pleuritis (VC, P = 0.019; FEV1, P = 0.003) and an ablated parenchymal volume C≥20 cm3 (VC, P = 0.047; FEV1, P = 0.038) were independent factors for impaired VC and FEV1. Conclusions Pulmonary function decreased after RFA. RFA-induced severe pleuritis and ablation of a large volume of marginal parenchyma were associated with impaired pulmonary function. © Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2011.

DOI： 10.1007/s00270-011-0221-z

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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：OXFORD UNIV PRESS  

Radiofrequency ablation has been applied as a minimally invasive therapy for the local control of lung tumors, including primary and metastatic neoplasms. Hemorrhagic complications after radiofrequency ablation can usually be treated conservatively, but such complications can be massive and fatal in some cases. In this paper, we report the rare case of delayed massive hemothrax caused by the rupture of a pulmonary artery pseudoaneurysm after lung radiofrequency ablation that was treated using transcatheter coil embolization followed by a left lower lobectomy. A 75-year-old woman underwent radiofrequency ablation for the treatment of a metastatic lung tumor in the left lower lobe arising from a colorectal carcinoma located close to a branch of the pulmonary artery. Thirty-six hours later, hemothorax and hemorrhagic shock occurred as a result of a ruptured pulmonary artery pseudoaneurysm and radiofrequency ablation-induced damage to the interlobular pleura. After transcatheter coil embolization of the pulmonary artery pseudoaneurysm, she recovered from a state of shock and a left lower lobectomy was performed. Histological findings revealed the presence of residual tumor cells in the ablated lung tumor. The postoperative course was uneventful, and no evidence of recurrence of the primary disease was seen at 1 year after the surgery. Although hemothorax secondary to the rupture of a pulmonary artery pseudoaneurysm after lung radiofrequency ablation is a rare complication, it should be recognized as a serious potential complication of lung radiofrequency ablation for a tumor located close to the pulmonary artery branch. © The Author 2012. Published by Oxford University Press. All rights reserved.

DOI： 10.1093/jjco/hys068

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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：ELSEVIER SCIENCE INC  

Purpose: To retrospectively investigate the incidence of and risk factors for phrenic nerve injury after radiofrequency (RF) ablation of lung tumors. Materials and Methods: The study included 814 RF ablation procedures of lung tumors. To evaluate the development of phrenic nerve injury, chest radiographs obtained before and after the procedure were examined. Phrenic nerve injury was assumed to have developed if the diaphragmatic level was elevated after the procedure. To identify risk factors for phrenic nerve injury, multiple variables were compared between cases of phrenic nerve injury and randomly selected controls by using univariate analyses. Multivariate analysis was then performed to identify independent risk factors. Results: Evaluation of phrenic nerve injury from chest radiographs was possible after 786 procedures. Evidence of phrenic nerve injury developed after 10 cases (1.3%). Univariate analysis revealed that larger tumor size (< 20 mm; P =.014), proximity of the phrenic nerve to the tumor (< 10 mm; P <.001), the use of larger electrodes (array diameter or noninsulated tip length < 3 cm; P =.001), and higher maximum power applied during ablation (< 100 W; P <.001) were significantly associated with the development of phrenic nerve injury. Multivariate analysis demonstrated that the proximity of the phrenic nerve to the tumor (< 10 mm; P <.001) was a significant independent risk factor. Conclusions: The incidence of phrenic nerve injury after RF ablation was 1.3%. The proximity of the phrenic nerve to the tumor was an independent risk factor for phrenic nerve injury. © 2012 SIR.

DOI： 10.1016/j.jvir.2012.02.014

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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：ELSEVIER IRELAND LTD  

Objective: The objective of our study was to retrospectively determine the diagnostic yield of CT fluoroscopy-guided cutting needle biopsy of focal pure ground-glass opacity lung lesions. Materials and methods: Biopsies were performed using 20-G coaxial cutting needles for 83 focal pure ground-glass opacity lung lesions (mean lesion size, 12.1 mm). After excluding the lesions for which biopsy specimens were unobtainable and final diagnoses were undetermined, the diagnostic yield, including sensitivity and specificity for a diagnosis of malignancy and accuracy, was calculated. The lesions were then divided into 2 groups: the diagnostic failure group, comprising lesions with false-negative results and for which a biopsy specimen was unobtainable; and the diagnostic success group, comprising lesions with true-negative results and true-positive results. Various variables were compared between the 2 groups by univariate analysis. Results: Biopsy specimens were obtained from 82 lesions, while specimens could not be obtained from 1 lesion. Final diagnosis was undetermined in 16 lesions. The sensitivity and specificity for a diagnosis of malignancy were 95% (58/61) and 100% (5/5), respectively. Diagnostic accuracy was 95% (63/66). The 4 lesions in diagnostic failure group were smaller, deeper, and more likely to be located in the lower lobe and further, for those lesions, number of specimens obtained was smaller, compared with 63 lesions in diagnostic success group. However, none of the differences were statistically significant. Conclusion: CT fluoroscopy-guided cutting needle biopsy provided high diagnostic yield for focal pure ground-glass opacity lung lesions. © 2010 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.ejrad.2010.11.025

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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：SPANDIDOS PUBL LTD  

Activating mutations of the epidermal growth factor receptor (EGFR) gene are characteristic of non-small cell lung cancer (NSCLC). EGFR mutations were previously detected in histologically normal lung tissue around NSCLC tumors. Computed tomography-guided lung needle biopsy (CTNB) is an accurate and useful technique for the diagnosis of lung tumors. However, pathologically non-malignant cases occasionally become apparent following lung tumor resection. In this study, we determined the EGFR mutational status of lung tumors diagnosed as non-malignant in CTNB specimens, but diagnosed as NSCLC following surgical resection. Between 2000 and 2008, 1,109 CTNBs were performed at Okayama University Hospital. Among them, 15 cases were initially diagnosed as non-malignant by CTNB, but diagnosed as NSCLC following surgical resection as a result of a high likelihood of malignancy by clinical findings. Twelve paired DNAs of CTNB and corresponding resected specimens were available to examine the EGFR mutational status using a mutant-enriched PCR assay. EGFR mutations were detected in one out of 12 CTNB specimens and three of the corresponding resected tumors. This case harbored the same EGFR mutation in the CTNB specimen and resected tumor, but not in the distant corresponding non-malignant lung tissue. Our results indicated that the detection of EGFR mutations may therefore aid the diagnosis of NSCLC in pathologically non-malignant CTNB specimens.

DOI： 10.3892/ol.2011.471

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

The present report describes three cases of a bronchiolitis obliterans organizing pneumonia (BOOP)-like reactive pneumonitis following radiofrequency (RF) ablation for lung cancer. The incidence of BOOP-like reactive pneumonitis after RF ablation at the authors' institution was estimated to be approximately 0.4% (three of 840 sessions). The patients presented with nonspecific symptoms. Computed tomography images showed consolidation or ground-glass opacity in a peripheral-dominant distribution and/or patchy air-space opacities. The disease was nonresponsive to antibiotic therapy but responded favorably to pulse therapy of steroids. BOOP-like reactive pneumonitis should be recognized as a complication following lung RF ablation. © 2012 SIR.

DOI： 10.1016/j.jvir.2011.09.011

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担当区分：筆頭著者,　責任著者   記述言語：英語  

The early results (e.g., patient survival) of RFA for the treatment of patients with NSCLC and pulmonary metastasis from various primary lesions including colorectal cancer, lung cancer, hepatocellular carcinoma, renal cell carcinoma, and sarcoma appear encouraging and suggest the potential to offer long-term survival for the patients with oligo-recurrence or oligometastasis of lung cancer. The usefulness of RFA for oligo-recurrence or oligometastasis of lung cancer should be clarified by prospective studies in the future. Copyright © 2012 Takao Hiraki and Susumu Kanazawa.

DOI： 10.1155/2012/196173

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記述言語：日本語   出版者・発行元：(株)学研メディカル秀潤社  

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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：OKAYAMA UNIV MED SCHOOL  

The aim of the present study was to assess the diagnostic usefulness of Fluorine-18 fluorodeoxyglucose ( 18F-FDG) positron emission tomography/computed tomography (PET/CT) in the prediction of local recurrence of malignant lung tumors by analyzing the pre-radiofrequency ablation (RFA) maximal standardized uptake value (SUV max). We performed a historical cohort study of consecutive malignant lung tumors treated by RFA from January 2007 to May 2008 at Okayama University Hospital. We selected only lung tumors examined by PET/CT within 90 days before RFA and divided them (10 primary and 29 metastatic) into 3 groups according to their tertiles of SUV max. We calculated recurrence odds ratios in the medium group and the high group compared to the low group using multivariate logistic analysis. After we examined the relationship between SUV max and recurrence in a crude model, we adjusted for some factors. Tumors with higher SUV max showed higher recurrence odds ratios (medium group; 1.84, high group; 4.14, respectively). The tumor size also increased the recurrence odds ratio (2.67); we thought this was mainly due to selection bias because we excluded tumors less than 10 mm in diameter. This study demonstrated the pre-RFA SUV max in PET/CT may be a prognostic factor for local recurrence of malignant lung tumors. © 2011 by Okayama University Medical School.

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担当区分：筆頭著者,　責任著者   記述言語：英語   出版者・発行元：ELSEVIER SCIENCE INC  

DOI： 10.1016/j.jvir.2011.08.014

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：OKAYAMA UNIV MED SCHOOL  

The application of radiofrequency ablation for the treatment of lung cancer by our group at Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences began in June 2001, and in the present report, we review our 10-year experience with this treatment modality at Okayama University Hospital. The local efficacy of radiofrequency ablation for the treatment of lung cancer depends on tumor size and the type of electrode used, but not on tumor type. An important factor for the prevention of local failure may be the acquisition of an adequate ablative margin. The combination of embolization and radiation therapy enhances the local efficacy. Local failure may be salvaged by repeating the radiofrequency ablation, particularly in small tumors. Survival rates after radiofrequency ablation are quite promising for patients with clinical stage I non-small cell lung cancer and pulmonary metastasis from colorectal cancer, hepatocellular carcinoma, and renal cell carcinoma. The complications caused by radiofrequency ablation can be treated conservatively in the majority of cases. However, attention should be paid to rare but serious complications. This review shows that radiofrequency ablation is a promising treatment for patients with lung cancer.

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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：LIPPINCOTT WILLIAMS & WILKINS  

Purpose: Evaluating the status of disease progression is critical for planning a therapeutic strategy for esophageal cancer. In this regard, F-18 fluorodeoxyglucose-labeled positron emission tomography (PET) is one of the most useful diagnostic modalities. However, there is room to improve its diagnostic performance, such as distinguishing lymph nodal metastases from false positives. In this study, we examined the diagnostic accuracy of fluorodeoxyglucose PET accompanied by computed tomography imaging (PET/CT) to detect regional lymph nodal metastasis from esophageal squamous cell carcinoma (ESCC). Methods: A total of 102 patients diagnosed as ESCC were subjected to this study. These patients had a preoperative PET/CT examination to evaluate the existence of metastasis. The values of maximum standardized uptake value (SUV max) in primary tumors and in metastasized lymph nodes were measured to analyze their relationship with various clinicopathologic characteristics including the status of tumor cell proliferation, which was assessed by immunohistochemistry for Ki-67. Results: The SUV max of the primary tumor was positively correlated with tumor size and vessel invasion, and was positively related with the SUV max of lymph nodal metastasis, especially in cases of poorly differentiated ESCC. The SUV max of metastasized lymph nodes was higher in larger-sized metastasized lymph nodes, whereas the Ki-labeling index of lymph nodal metastasis was positively related with the SUV max per unit area (SUV max/mm 2). The diagnostic accuracy of PET/CT (87.3%) was higher than that of conventional CT scans (78.4%). Conclusions: The improved diagnostic accuracy of PET/CT can be explained by its ability to detect actively progressive metastasis at an early phase regardless of size. Copyright © 2011 by Lippincott Williams & Wilkins.

DOI： 10.1097/RLU.0b013e318217adc9

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

Objective: This study aimed at retrospectively evaluating the outcomes of radiofrequency ablation of clinical stage I non-small cell lung cancer. Methods: This study was carried out on 50 nonsurgical candidates (29 men and 21 women; mean age, 74.7 years) with clinical stage I (IA, n = 38; IB, n = 12) histologically proven non-small cell lung cancer. A total of 52 tumors were treated with 52 ablation sessions. Radiofrequency ablation was performed percutaneously under computed tomography fluoroscopic guidance. The outcomes of radiofrequency ablation were evaluated, including toxicity, local efficacy, and patient survival. Toxicity was evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0. Local efficacy was evaluated by using computed tomography scan with a contrast medium. The overall, cancer-specific, and disease-free survivals were estimated with Kaplan-Meier analysis. Results: Grade 2 and 3 adverse events occurred after 6 (12%) and 3 (6%) of the 52 sessions, respectively. The median follow-up period was 37 months. Local progression was observed in 16 (31%) of the 52 tumors. The median survival time was 67 months. The overall, cancer-specific, and disease-free survivals were 94%, 100%, and 82% at 1 year, 86%, 93%, and 64% at 2 years, and 74%, 80%, and 53% at 3 years, respectively. Conclusions: Radiofrequency ablation of clinical stage I non-small cell lung cancer was minimally invasive and provided promising patient survival, although the local efficacy needs to be improved. Copyright © 2011 by The American Association for Thoracic Surgery.

DOI： 10.1016/j.jtcvs.2011.02.036

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

Purpose: To retrospectively evaluate technical success, effectiveness, complications, patient survival, and prognostic factors with percutaneous radiofrequency (RF) ablation for pulmonary metastases resulting from hepatocellular carcinoma (HCC). Materials and Methods: Thirty-two patients from six institutions were included, with a total of 83 pulmonary metastases treated in 65 sessions. RF ablation was always performed percutaneously with computed tomography (CT) guidance. Primary endpoints were technical success and technique effectiveness. Technique effectiveness was evaluated based on sequential follow-up CT images. Secondary study endpoints were complications, patient survival, and determination of prognostic factors. Complications were classified as major or minor. Prognostic factors were determined by analyzing multiple variables with the log-rank test. Results: Technical success rate was 100%. Primary technique effectiveness rates were 92% each at 1, 2, and 3 years. Major and minor complications occurred after 16 (25%) and 23 (35%) of the 65 sessions, respectively. The median follow-up period was 20.5 months. Overall survival rates were 87% at 1 year and 57% each at 2 and 3 years (median and mean survival times, 37.7 mo and 43.2 mo, respectively). Significantly better survival rates were obtained in cases of (i) no viable intrahepatic recurrence (P < .001), (ii) Child-Pugh class A disease (P < .001), (iii) absence of liver cirrhosis (P < .001), (iv) absence of hepatitis C virus infection (P = .006), and (v) α-fetoprotein level of 10 ng/mL or lower (P = .007) at the time of RF ablation. Conclusions: RF ablation appears effective, with an acceptable safety profile, in selected patients with pulmonary metastases resulting from HCC. © 2011 SIR.

DOI： 10.1016/j.jvir.2011.02.030

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記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

This report describes seven cases in which a pneumothorax was artificially created for relief from severe pain that occurred during radiofrequency (RF) ablation of peripheral lung tumors. In this procedure, the multitined probe surrounding the lesion was advanced into the chest, displacing the tines and the peripheral tumor away from the parietal pleura and the chest wall and resulting in pain relief in one patient; in the remaining patients, an intravenous catheter was also introduced, followed by the administration of carbon dioxide (CO2) into the space between the tumor and the parietal pleura. The pain decreased considerably immediately after this procedure. No complication related to the creation of the artificial pneumothorax was observed. Creation of an artificial pneumothorax is a safe and effective method for pain relief. © 2011 SIR.

DOI： 10.1016/j.jvir.2010.12.018

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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：CIG MEDIA GROUP, LP  

Computed tomography (CT)-guided lung biopsy is occasionally used for the lesions that were diagnosed as nonmalignant by transbronchial examination despite the fact that other clinical data suggested those as malignant. The purpose of this study is to evaluate the outcomes of CT fluoroscopy-guided cutting needle biopsy of lung lesions after transbronchial examination resulting in negative diagnosis. Patients and Methods: We retrospectively evaluated the outcomes of CT fluoroscopy-guided lung biopsy for 351 lesions (mean size, 2.8 cm) that were found to be nonmalignant by transbronchial examination. Diagnostic yield, including sensitivity and specificity for the diagnosis of malignancy, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Various variables were analyzed to determine the factors for diagnostic failure. Results: The biopsy result was nondiagnostic, true-positive, true-negative, false-positive, or false-negative for 2, 262, 70, 0, or 17 lesions, respectively. Thus, the sensitivity, specificity, PPV, NPV, and accuracy of CT fluoroscopy-guided cutting needle biopsy was found to be 93% (262/281), 100% (70/70), 100% (262/262), 80% (70/87), and 94% (332/351), respectively. There was no significant risk factor for diagnostic failure. Conclusion: Computed tomography fluoroscopy-guided cutting needle lung biopsy is a useful technique to correct or confirm negative diagnosis by transbronchial examination.

DOI： 10.3816/CLC.2011.n.007

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担当区分：筆頭著者,　責任著者   掲載種別：論文集(書籍)内論文  

Radiofrequency (RF) ablation is a thermal therapy that results in coagulation necrosis. Initially, RF ablation was mainly used for treating hepatocellular carcinoma. Favorable outcomes in the treatment of hepatocellular carcinoma have encouraged the application of this technique to neoplasms in other organs, including the lungs. RF ablation for lung cancer may be carried out percutaneously by using computed tomographic (CT) guidance; the techniques used in this therapy are simple and quite similar to those used in CT-guided lung biopsy. Mortality rate has been reported to be 0.4%. There have been promising survival data after RF ablation: 68% at 2 years, 74% at 3 years, and 75% at 2 years for patients with clinical stage I non-small-cell lung cancer; and 66% at 2 years and 46%-48% at 3 years for patients with metastatic colorectal cancer. Therefore, RF ablation of lung cancer is currently one of the hot topics in interventional radiology. In this commentary, we describe the outcomes of RF ablation as a novel therapy for pulmonary metastasis from colorectal cancer. © 2011 Nova Science Publishers, Inc. All rights reserved.

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記述言語：日本語   出版者・発行元：金原出版(株)  

胃MALTリンパ腫(H.pylori(HP)陽性群;MALT-HP(+)群、HP陰性;MALT-HP(-)群)、高悪性度の胃リンパ腫(高悪性度群)の3群におけるPET/CTでの視覚的評価、SUVmaxの比較およびSUVmaxの程度による3分類(軽度、中等度、高度集積)と3群の関連性について検討した。MALT-HP(-)群、MALT-HP(+)群、高悪性度群の順で有意にSUVmaxが高かった。病変部のPETでの集積程度をSUVmaxの5、10をcut offに3分類(軽度、中等度、高度集積)とMALT-HP(-)群、MALT-HP(+)群、高悪性度群との関連性もみられた。胃MALTリンパ腫でSUVが10以上の場合は、高悪性度群への転化が示唆されると考えられた。

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Dr. Takao Hiraki is a scientist carrying out interventional radiology research in the Department of Radiology at Okayama University Medical School, Japan. He has conducted animal and human clinical studies on interventional radiology for various conditions. For example, he clarified the hepatic hemodynamic changes caused by hepatic venous occlusion. He also developed new devices, such as hydrogel coils for the occlusion of the aneurismal sac after an endovascular stent-graft of an aortic aneurysm to prevent endoleakage and small intestinal submucosa-covered stents for transjugular intrahepatic portosystemic shunts. Further, he performed a number of studies on the radiofrequency ablation of lung cancer, mediastinal lymph node metastasis, and computed tomography-fluoroscopy-guided lung biopsies. He intends to continue to dedicate his academic career to expand the role of interventional radiology in clinical medicine.

DOI： 10.4329/wjr.v2.i12.474

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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：SPRINGER  

Objective The purpose of this study was to evaluate retrospectively the safety and effectiveness of the computed tomography (CT) fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures. Materials and methods Six patients (four women and two men; mean age 55.8 years; range 35-77 years) with unstable posterior pelvic fractures underwent iliosacral screw placement under CT fluoroscopy guidance between November 2007 and August 2008. Unstable pelvic rin injury (AO types B and C) was the indication for this procedure. Results In all the six patients except one, CT fluoroscopyguided placement had been technically successful. In one patient, a second screw had been inserted, with a tilt to the caudal site, and slightly advanced into the extrasacral body; afterward, it could be exchanged safely for a shorter screw. Five patients and one patient underwent placement of two screws and one screw, respectively. The mean duration of the procedure was 15.0 min (range 9-30 min) per screw; the duration was 12.3 min and 18.2 min for the first and second screws, respectively. No complications requiring treatment occurred during or after the procedure. The mean clinical and radiologic follow-up period was 14 months (range 6-21 months). All pelvic injuries had healed satisfactorily, without complication, and all patients are now doing well clinically and can walk. Conclusion CT fluoroscopy-guided placement of iliosacral screws is a safe and effective treatment in patients with unstable posterior pelvic fractures. © ISS 2009.

DOI： 10.1007/s00256-009-0826-3

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担当区分：筆頭著者,　責任著者   記述言語：英語   出版者・発行元：ELSEVIER SCIENCE INC  

DOI： 10.1016/j.jvir.2010.03.017

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

The present report describes four cases of brachial nerve injury caused by percutaneous radiofrequency (RF) ablation of lung cancer. All the tumors were located in the lung apex. The patients developed symptoms indicative of a low brachial plexus injury during RF ablation or as long as 7 days afterward. These symptoms partially receded over time. The indications of RF ablation in patients with apical lung cancer should be carefully determined because of the risk of brachial nerve injury associated with the procedure. © 2010 SIR.

DOI： 10.1016/j.jvir.2010.03.007

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER IRELAND LTD  

Objective: : To retrospectively evaluate the effect of tumor type on local control by radiofrequency ablation in the lungs. Materials and methods: : This study included 252 lung tumors (mean size, 13.5 mm) in 105 patients (73 men and 32 women; mean age, 66.6 years) who underwent radiofrequency ablation with a multitined expandable electrode. Those tumors comprised five tumor types: primary lung cancer (n = 35) and pulmonary metastases from colorectal cancer (n = 117), lung cancer (n = 23), renal cell carcinoma (n = 49), and hepatocellular carcinoma (n = 28). Local control was evaluated with contrast-enhanced computed tomography. The overall local control rates were estimated as well as those for each tumor type using the Kaplan-Meier analysis. Local control rates for a given tumor type were compared with those for the four other types. Then, multivariate multilevel analysis was performed using the variables of tumor type, tumor size, contact with a vessel or bronchus, and procedure period. Results: : The overall local control rates were 97%, 86%, 81%, and 76% at 6, 12, 18, and 24 months, respectively. Local control rates varied among the tumor types, and metastatic colorectal cancer showed significantly (P = .023) higher local control rates than those of the four other types. However, multivariate analysis indicated that the relative risk of local progression for a given tumor type was comparable to the risks for the four other types. Conclusion: : Tumor type per se did not significantly influence local control. © 2009 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.ejrad.2009.01.026

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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：SPRINGER  

We describe a case of pulmonary artery (PA) pseudoaneurysm related to radiofrequency ablation (RFA) of lung tumor. We performed RFA for a pulmonary epithelioid hemangioendothelioma directly adjacent to a branch of the PA. Seventeen days later, the patient complained of hemoptysis. A chest CT image revealed PA pseudoaneurysm. Transcatheter coil embolization was performed 59 days after RFA. Although PA pseudoaneurysm is rare, with an incidence of 0.2% (1/538 sessions) at our institution, it should be recognized as a risk when treating lung tumors adjacent to a branch of the PA. © Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2009.

DOI： 10.1007/s00270-009-9565-z

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AMER ROENTGEN RAY SOC  

OBJECTIVE. The objective of our study was to retrospectively evaluate the incidence of and the risk factors for pneumothorax and chest tube placement after CT fluoroscopy-guided lung biopsy. MATERIALS AND METHODS. We analyzed 1,098 CT fluoroscopy-guided lung biopsies conducted with 20-gauge coaxial cutting needles for 1,155 lesions in 1,033 patients. Apart from evaluating the incidence of pneumothorax and chest tube placement, the independent risk factors for pneumothorax and chest tube placement for pneumothorax were determined using multivariate logistic regression analysis. RESULTS. The overall incidence of pneumothorax was 42.3% (464/1,098). Chest tube placement was required for 11.9% (55/464) of pneumothoraces (5.0% [55/1,098] of the total number of procedures). The significant independent risk factors for pneumothorax were no prior pulmonary surgery (p = 0.001), lesions in the lower lobe (p < 0.001), greater lesion depth (p < 0.001), and a needle trajectory angle of < 45° (p = 0.014); those for chest tube placement for pneumothorax were pulmonary emphysema (p < 0.001) and greater lesion depth (p < 0.001). CONCLUSION. Pneumothorax frequently occurred and placement of a chest tube was occasionally required for pneumothorax after CT fluoroscopy-guided lung biopsy. To reduce the risk of pneumothorax necessitating chest tube placement, physicians should adopt the shortest needle path to the lesion. © American Roentgen Ray Society.

DOI： 10.2214/AJR.09.3224

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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：ELSEVIER SCIENCE INC  

Purpose: To determine which lung metastases are most likely to be treated effectively with a single radiofrequency (RF) application (defined as two separate applications of RF energy at a single electrode position) with a multitined expandable electrode with arrays 2 cm in diameter. Materials and Methods: The authors retrospectively evaluated 88 lung metastases (mean long-axis diameter, 0.9 cm) in 36 patients (20 men and 16 women; mean age, 57 years) treated with a single RF application with a multitined expandable electrode with arrays 2 cm in diameter. Based on follow-up computed tomographic examinations, the technique effectiveness rates were estimated with Kaplan-Meier analysis. Multiple variables were analyzed with the log-rank test to determine risk factors for local progression. Then, the technique effectiveness rates were again estimated when considering only metastases without risk factors and compared with those of other tumors. Results: The median follow-up period was 13.2 months (range, 6.0-24.7 months). Tumor size greater than 1.0 cm (P = .033) and contact with the bronchus with an inner diameter of at least 2 mm (P = .047) were the significant risk factors for local progression. The technique effectiveness rates for metastases 1.0 cm or smaller that were not in contact with the bronchus (n = 59) were 96% at 1 year and at 2 years; those rates were significantly (P = .010) higher than those in other tumors (n = 29). Conclusions: A single RF application with a multitined expandable electrode with arrays 2 cm in diameter is most likely to suffice in small (≤1 cm) lung metastases not in contact with a bronchus. © 2010 SIR.

DOI： 10.1016/j.jvir.2009.09.028

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記述言語：日本語   出版者・発行元：(一社)日本インターベンショナルラジオロジー学会  

総合周産期母子医療センター(全国75施設)における産科出血に対するIVRの施行状況および産科医と放射線科医のIVRに対する認識を調査した。質問票を送付した75施設中、産科医、放射線科医ともに48施設から回答が得られた。産科出血に対するIVRについて、46施設の産科医が「知っている」と回答した。産科出血に対するIVRのうち、緊急の出血コントロールのIVRは、放射線科医の94%、産科医の75%が、過去5年間に施行経験があると回答した。IVRは、手技の87%が放射線科医により施行されているが、産婦人科医や血管外科医、救急医が施行している施設もみられた。緊急の出血コントロールのIVRは、「大量出血があり血行動態が安定している場合」を適応とする回答が最多(77〜81%)であった。産科出血のIVRについて、「積極的に施行したい」という回答が最も多かった(54〜58%)。

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記述言語：日本語   出版者・発行元：(公社)日本医学放射線学会  

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記述言語：日本語   出版者・発行元：(公社)日本医学放射線学会