Okayama University Medical School Acta Medica Okayama 0386-300X 76 1 2022 In Vivo Microwave Ablation of Normal Swine Lung at High-power, Short-duration Settings 57 62 EN Toshihiro Iguchi Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takao Hiraki Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yusuke Matsui Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomohiro Toji Department of Pathology, Okayama University Hospital Mayu Uka Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Koji Tomita Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyuki Komaki Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Noriyuki Umakoshi Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Okayama University Hospital Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/63212 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. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 1 2022 Development and Evaluation of a Short-time Imaging Method for the Clinical Study of the Apparent Diffusion Coefficient Subtraction Method 25 32 EN Kohei Sugimoto Radiological Technology, Graduate School of Health Sciences, Okayama University Masahiro Kuroda Radiological Technology, Graduate School of Health Sciences, Okayama University Yuuki Yoshimura Radiological Technology, Graduate School of Health Sciences, Okayama University Kentaro Hamada Radiological Technology, Graduate School of Health Sciences, Okayama University Abdullah Khasawneh Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Majd Barham Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nouha Tekiki Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kohei Konishi Radiological Technology, Graduate School of Health Sciences, Okayama University Hinata Ishizaka Radiological Technology, Graduate School of Health Sciences, Okayama University Yudai Shimizu Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Nakamitsu Radiological Technology, Graduate School of Health Sciences, Okayama University Wlla E. Al-Hammad Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryo Kamizaki Radiological Technology, Graduate School of Health Sciences, Okayama University Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Junichi Asaumi Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/63205 The apparent diffusion coefficient subtraction method (ASM) was developed as a new restricted diffusionweighted imaging technique for magnetic resonance imaging (MRI). The usefulness of the ASM has been established by in vitro basic research using a bio-phantom, and clinical research on the application of the ASM for the human body is needed. Herein, we developed a short-time sequence for ASM imaging of the heads of healthy volunteers (n=2), and we investigated the similarity between the obtained ASM images and diffusion kurtosis (DK) images to determine the utility of the ASM for clinical uses. This study appears to be the first to report ASM images of the human head. We observed that the short-time sequence for the ASM imaging of the head can be scanned in approx. 3 min at 1.5T MRI. The noise reduction effect of median filter processing was confirmed on the ASM images scanned by this sequence. The obtained ASM images showed a weak correlation with the DK images, indicating that the ASM images are restricted diffusion-weighted images. The new shorttime imaging sequence could thus be used in clinical studies applying the ASM. No potential conflict of interest relevant to this article was reported.

Springer nature Acta Medica Okayama 2509-9280 4 1 2021 Bone microarchitectural analysis using ultra-high-resolution CT in tiger vertebra and human tibia 4 EN Ryota Inai Department of Radiology, Okayama University Medical School Ryuichi Nakahara Intelligent Orthopaedic System Development, Okayama University Medical School Yusuke Morimitsu Devision of Radiology, Medical Support Department, Okayama University Hospital Noriaki Akagi Devision of Radiology, Medical Support Department, Okayama University Hospital Youhei Marukawa Department of Radiology, Okayama University Medical School Toshi Matsushita Devision of Radiology, Medical Support Department, Okayama University Hospital Takashi Tanaka Department of Radiology, Okayama University Medical School Akihiro Tada Department of Radiology, Okayama University Medical School Takao Hiraki Department of Radiology, Okayama University Medical School Yoshihisa Nasu Medical materials for musculoskeletal reconstruction, Okayama University Medical School Keiichiro Nishida Orthopaedic Surgery, Okayama University Medical School Toshifumi Ozaki Orthopaedic Surgery, Okayama University Medical School Susumu Kanazawa Department of Radiology, Okayama University Medical School 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/cm(3) and 63.5 mg/cm(3)versus 20.8 mg/cm(3)), 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/mm(3) and 0.74 l/mm(3)versus 0.02 l/mm(3), 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/mm(3)versus 0.22 l/mm(3), respectively). Conclusions We observed characteristic trends in microarchitectural parameters and demonstrated the potential utility of applying UHRCT for microarchitectural analysis. No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 0959-8049 153 2021 Phase I dose-escalation study of endoscopic intratumoral injection of OBP-301 (Telomelysin) with radiotherapy in oesophageal cancer patients unfit for standard treatments 98 108 EN Yasuhiro Shirakawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Tazawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shunsuke Tanabe Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nobuhiko Kanaya Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuhiro Noma Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takeshi Koujima Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hajime Kashima Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takuya Kato Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinji Kuroda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Satoru Kikuchi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shunsuke Kagawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kuniaki Katsui Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasuo Urata Oncolys BioPharma, Inc. Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Purpose: OBP-301 (Telomelysin) is an attenuated type-5 adenovirus that contains the human telomerase reverse transcriptase promoter to regulate viral replication. OBP-301 sensitises human cancer cells to ionising radiation by inhibiting DNA repair, and radiation enhances coxsackievirus and adenovirus receptor-mediated OBP-301 infection on the contrary. We assessed OBP-301 with radiotherapy in oesophageal cancer patients unfit for standard chemoradiation treatments. Methods: A phase I dose-escalation study of OBP-301 with radiotherapy was conducted in 13 histologically confirmed oesophageal cancer patients deemed unfit to undergo surgery or chemotherapy. Study treatment consisted of OBP-301 administration by intratumoural needle injection using a flexible endoscope on days 1, 18 and 32. Radiotherapy was administered concurrently over 6 weeks, beginning on day 4, to a total of 60 Gy. Results: Of the 13 patients, 7, 3 and 3 patients were treated with 10(10), 10(11) and 10(12) virus particles, respectively. Study group comprised 10 males and 3 females, with a median age of 82 years (range, 53-91 years). All patients developed a transient, self-limited lymphopenia. Distribution studies revealed transient virus shedding in the plasma. Eight patients had local complete response (CR); all of them exhibited no pathologically viable malignant cells in biopsy specimens, and 3 patients had a partial response. The objective response rate was 91.7%. The clinical CR rate was 83.3% in stage I and 60.0% in stage II/III. Histopathological examination revealed massive infiltration of CD8 thorn cells and increased PD-L1 expression. Conclusion: Multiple courses of endoscopic intratumoural OBP-301 injection with radiotherapy are feasible and provide clinical benefits in patients with oesophageal cancer unfit for standard treatments. (C) 2021 Elsevier Ltd. All rights reserved. No potential conflict of interest relevant to this article was reported.

Spandidos Publications Acta Medica Okayama 2049-9450 15 3 2021 New field‑in‑field with two reference points method for whole breast radiotherapy: Dosimetric analysis and radiation‑induced skin toxicities assessment EN Nouha Tekiki Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masahiro Kuroda Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Hinata Ishizaka Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Abdullah Khasawneh Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Majd Barham Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kentaro Hamada Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Kohei Konishi Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Kohei Sugimoto Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Kuniaki Katsui Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Soichi Sugiyama Department of Radiology, Okayama University Hospital Kenta Watanabe Department of Radiology, Okayama University Hospital Kotaro Yoshio Department of Radiology, Okayama University Hospital Norihisa Katayama Department of Radiology, Kagawa Prefectural Central Hospital Takeshi Ogata Department of Radiology, Iwakuni Clinical Center Hiroki Ihara Department of Radiology, Tsuyama Chuo Hospital Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Junichi Asaumi Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences The usefulness of the field‑in‑field with two reference points (FIF w/ 2RP) method, in which the dose reference points are set simultaneously at two positions in the irradiation field and the high‑dose range is completely eliminated, was examined in the present study with the aim of decreasing acute skin toxicity in adjuvant breast radiotherapy (RT). A total of 573 patients with breast cancer who underwent postoperative whole breast RT were classified into 178 cases with wedge (W) method, 142 cases with field‑in‑field without 2 reference points (FIF w/o 2RP) method and 253 cases with FIF w/ 2RP method. Using the FIF w/ 2RP method, the high‑dose range was the lowest among the three irradiation methods. The planning target volume (PTV) V105% and the breast PTV for evaluation (BPe) V105% decreased to 0.09 and 0.10%, respectively. The FIF w/ 2RP method vs. the FIF w/o 2RP method had a strong association (η) with PTV V105% (η=0.79; P<0.001) and BPe V105% (η=0.76; P<0.001). The FIF w/ 2RP method had a significant impact on lowering the skin toxicity grade in weeks 3 and 4, and increasing the occurrence of skin toxicity grade 0. The FIF w/ 2RP method vs. the W method had a moderate association with skin toxicity grade at week 3 (η=0.49; P<0.001). Using the FIF w/ 2RP method, the high‑dose range V105% of the target decreased to 0%, and skin adverse events were decreased in conjunction. For patients with early‑stage breast cancer, particularly patients with relatively small‑sized breasts, the FIF w/ 2RP method may be an optimal irradiation method. No potential conflict of interest relevant to this article was reported.

Nature Research Acta Medica Okayama 2045-2322 11 1 2021 Sarcopenia is associated with poor prognosis after chemoradiotherapy in patients with stage III non-small-cell lung cancer: a retrospective analysis 11882 EN Kuniaki Katsui Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takeshi Ogata Department of Radiology, Iwakuni Clinical Center Soichi Sugiyama Department of Radiology, Okayama University Hospital Kotaro Yoshio Department of Radiology, Okayama University Hospital Masahiro Kuroda Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Takao Hiraki Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Katsuyuki Kiura Department of Allergy and Respiratory Medicine, Okayama University Hospital Yoshinobu Maeda Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Shinichi Toyooka Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences 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. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1867-1071 39 2021 Imaging evaluation of hereditary renal tumors: a pictorial review 619 632 EN Takashi Tanaka Department of Radiology, Okayama University Hospital Akira Kawashima Department of Radiology, Mayo Clinic Yohei Marukawa Department of Radiology, Okayama University Hospital Takahiro Kitayama Department of Radiology, Okayama University Hospital Yoshihisa Masaoka Department of Radiology, Okayama University Hospital Katsuhide Kojima Department of Radiology, Okayama University Hospital Toshihiro Iguchi Department of Radiology, Okayama University Hospital Takao Hiraki Department of Radiology, Okayama University Hospital Susumu Kanazawa Department of Radiology, Okayama University Hospital 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. No potential conflict of interest relevant to this article was reported.

BMC Acta Medica Okayama 1748-717X 16 1 2021 Lung stereotactic body radiation therapy for elderly patients aged >= 80 years with pathologically proven early-stage non-small cell lung cancer: a retrospective cohort study 39 EN Kenta Watanabe Department of Radiology, Okayama University Hospital Kuniaki Katsui Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Soichiro Sugiyama Department of Radiology, Okayama University Hospital Kotaro Yoshio Department of Radiology, Okayama University Hospital Masahiro Kuroda Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Takao Hiraki Department of Radiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Katsuyuki Kiura Department of Allergy and Respiratory Medicine, Okayama University Hospital Yoshinobu Maeda Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry,and Pharmaceutical Sciences Shinichi Toyooka Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Background Stereotactic body radiation therapy (SBRT) is an established therapy for medically inoperable early-stage non-small cell lung cancer (NSCLC). Many elderly patients are medically inoperable owing to comorbidities. Therefore, SBRT may be a useful therapy for elderly patients. However, the application of SBRT for patients aged ≥ 80 years has not been completely elucidated. Therefore, this study aimed to assess the clinical utility of SBRT for elderly patients aged ≥ 80 years with pathologically proven early-stage NSCLC. Methods We retrospectively evaluated the data of patients aged ≥ 80 years with pathologically proven primary NSCLC who underwent SBRT at our institution between January 2009 and March 2020. Treatment outcomes and toxicities were analyzed. We used the Kaplan–Meier method to estimate survival curves and the log-rank test to compare the survival curves. We performed univariate and multivariate Cox regression analyses. p-values < 0.05 were regarded significant. Results Sixty-four patients (65 lesions) were included, and the median follow-up period was 38.7 (range 3.5–95.7) months. The median age was 82.9 (range 80.0–94.8) years. Sixteen patients were medically operable, and 48 patients were medically inoperable. The prescribed dose of SBRT was either 48 Gy in four fractions or 60 Gy in 10 fractions. The median survival time was 60.0 months (95% confidence interval, 43.5–71.1). The 1-, 3-, and 5-year local control, cancer-specific survival, progression-free survival, and overall survival rates were 98.4%, 98.4%, 81.0%, and 88.9%; 90.1%, 93.7%, 58.9%, and 68.3%; and 87.4%, 83.5%, 38.2%, and 47.5%, respectively. Multivariate analysis revealed that inoperability and solid nodules were the predictors of poor overall survival after SBRT in elderly patients. Two patients (3.1%) had grade 3 radiation pneumonitis, and one patient (1.6%) had grade 5 radiation pneumonitis. Conclusions SBRT was feasible in patients aged ≥ 80 years with NSCLC. It achieved good local control with minimal toxicity. SBRT may be beneficial in elderly patients with early-stage NSCLC. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 1 2021 Local Control of Squamous Cell Carcinoma of the Cervix Treated with CT-based Three-dimensional Image-Guided Brachytherapy with or without Central Shielding 79 85 EN Kotaro Yoshio Department of Radiology, Kagawa Prefectural Central Hospital Hisako Nagasaka Department of Obstetrics and Gynecology, Kagawa Prefectural Central Hospital Kento Hisazumi Department of Radiology, Kagawa Prefectural Central Hospital Hiro Okawa Department of Radiology, Kagawa Prefectural Central Hospital Nobuhisa Tajiri Department of Radiology, Kagawa Prefectural Central Hospital Tsuyoki Shiode Department of Radiology, Kagawa Prefectural Central Hospital Shiro Akaki Department of Radiology, Kagawa Prefectural Central Hospital Susumu Kanazawa Department of Radiology, Okayama University Hospital Tomohiro Mitoma Department of Obstetrics and Gynecology, Kagawa Prefectural Central Hospital Yuri Yano Department of Obstetrics and Gynecology, Kagawa Prefectural Central Hospital Emiko Kobayashi Department of Obstetrics and Gynecology, Kagawa Prefectural Central Hospital Ikuyo Horiguchi Department of Obstetrics and Gynecology, Kagawa Prefectural Central Hospital Masayo Takata Department of Obstetrics and Gynecology, Kagawa Prefectural Central Hospital Atsushi Hongo Department of Obstetrics and Gynecology 2, Kawasaki Medical School, General medical Center Masaru Yonezawa Department of Obstetrics and Gynecology, Kagawa Prefectural Central Hospital Yoshie Nakanishi Department of Obstetrics and Gynecology, Kagawa Prefectural Central Hospital Original Article 10.18926/AMO/61438 The purposes of this retrospective study were to analyze local control of squamous cell carcinoma of the cervix treated with computed tomography (CT)-based image-guided brachytherapy (IGBT), as well as the factors affecting local control. A total of 39 patients were analyzed. The prescribed dose to the pelvis was 45-50 Gy with or without central shielding (CS). IGBT was delivered in 1-5 fractions. The total dose for high-risk clinical target volume (HR-CTV) was calculated as the biologically equivalent dose in 2-Gy fractions. The median follow-up period was 29.3 months. The 2-year overall survival and local control rates were 97% and 91%, respectively. In univariate analysis, the dose covering 90% of the HR-CTV (D90) and tumor size were found to be significant factors for local control. The cutoff values of tumor size and D90 for local control were 4.3 cm (area under the curve [AUC] 0.75) and 67.7 Gy (AUC 0.84) in the CS group and 5.3 cm (AUC 0.75) and 73.7 Gy (AUC 0.78) in the group without CS, respectively. However, though the local control of CT-based IGBT was favorable, the results suggested that the dose required for tumor control may differ depending on the presence of CS. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 1 2021 Volumetric PET Parameters Predict Prognosis after Definitive Chemoradiotherapy with Cisplatin/Docetaxel for Stage III Non-Small Cell Lung Cancer 15 23 EN Kuniaki Katsui Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takeshi Ogata Department of Radiology, Iwakuni Clinical Center Akihiro Tada Department of Radiology, Okayama Diagnostic Imaging Center Soichi Sugiyama Department of Radiology, Okayama University Hospital Kotaro Yoshio Department of Radiology, Okayama University Hospital Masahiro Kuroda Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Katsuyuki Kiura Allergy and Respiratory Medicine, Okayama University Hospital Yoshinobu Maeda Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinichi Toyooka General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takao Hiraki Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/61429 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 chemo-radiotherapy (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 sur-vival. 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. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 1 2021 Needle Tract Ablation in Liver Tissue Using a Cryoprobe Combined with an Electrosurgical Device: Influence of ex vivo and in vivo Animal Models 9 14 EN Hideo Gobara Division of Medical Informatics, Okayama University Hospital Akira Yamamoto Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine Toshiyuki Komakic Department of Radiology, Okayama University Hospital Toshiaki Kitayama Department of Radiology, Otemae Hospital Jun Sakurai Center for Innovative Clinical Medicine, Okayama University Hospital Toshihiro Iguchi Department of Radiology, Okayama University Hospital Yusuke Matsui Department of Radiology, Okayama University Hospital Mayu Uka Department of Radiology, Okayama University Hospital Koji Tomita Department of Radiology, Okayama University Hospital Takao Hiraki Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/61428 To assess the feasibility of needle tract ablation in liver tissue in ex vivo and in vivo animal models using a cryo-probe and electrosurgical device. The experimental device is made by inserting a cryoprobe through an intro-ducer 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 per-formed using the experimental device and electrosurgical device. No potential conflict of interest relevant to this article was reported.

Springer Acta Medica Okayama 0938-7994 30 3 2019 Robotic CT-guided out-of-plane needle insertion: comparison of angle accuracy with manual insertion in phantom and measurement of distance accuracy in animals 1342 1349 EN Toshiyuki Komaki Department of Radiology, Okayama University Medical School Takao Hiraki Department of Radiology, Okayama University Medical School Tetsushi Kamegawa Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University Takayuki Matsuno Graduate School of Natural Science and Technology, Okayama University Jun Sakurai Center for Innovative Clinical Medicine, Okayama University Hospital Ryutaro Matsuura Graduate School of Health Sciences, Okayama University Medical School Takuya Yamaguchi Division of Radiology, Department of Medical Technology, Okayama University Hospital Takanori Sasaki Collaborative Research Center for OMIC, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Okayama University Hospital Soichiro Okamoto Department of Radiology, Okayama University Medical School Mayu Uka Department of Radiology, Okayama University Medical School Yusuke Matsui Department of Radiology, Okayama University Medical School Toshihiro Iguchi Department of Radiology, Okayama University Medical School Hideo Gobara Division of Medical Informatics, Okayama University Hospital Susumu Kanazawa Department of Radiology, Okayama University Medical School 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. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 5 2020 Combined Laparoscopic and CT Monitoring of the Ice-Ball Margin during Cryoablation for Renal Cell Carcinoma Associated with von Hippel-Lindau Disease: First Case 443 448 EN Takanori Sekito Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Motoo Araki Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takao Hiraki Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mayu Uka Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyuki Komaki Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yusuke Matsui Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshihiro Iguchi Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Satoshi Katayama Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kasumi Yoshinaga Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shogo Watari Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Maruyama Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yosuke Mitsui Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Risa Kubota Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takuya Sadahira Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shingo Nishimura Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Koichiro Wada Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Atsushi Takamoto Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kohei Edamura Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomoko Sako Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasuyuki Kobayashi Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toyohiko Watanabe Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasutomo Nasu Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/60806 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 cryoablation for RCC. No potential conflict of interest relevant to this article was reported.

AME Publoshing Company Acta Medica Okayama 2218-676X 9 8 2020 Radiation therapy for oligometastatic bone disease in breast cancer 5096 5101 EN Norihisa Katayama Department of Radiology, Okayama University Medical School Kuniaki Katsui Department of Radiology, Okayama University Medical School Kenta Watanabe Department of Radiology, Okayama University Medical School Ryota Nagao Department of Radiology, Okayama University Medical School Kaho Otsuki Department of Radiology, Okayama University Medical School Takao Hiraki Department of Radiology, Okayama University Medical School Susumu Kanazawa Department of Radiology, Okayama University Medical School 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. No potential conflict of interest relevant to this article was reported.

Springer Acta Medica Okayama 0941-1291 50 8 2020 Pulmonary aspergillosis as a late complication after surgery for locally advanced non-small cell lung cancer treated with induction chemoradiotherapy 863 871 EN Seiichiro Sugimoto Department of General Thoracic Surgery, Okayama University Hospital Junichi Soh Department of General Thoracic Surgery, Okayama University Hospital Ken Suzawa Department of General Thoracic Surgery, Okayama University Hospital Kentaroh Miyoshi Department of General Thoracic Surgery, Okayama University Hospital Shinji Otani Department of General Thoracic Surgery, Okayama University Hospital Hiromasa Yamamoto Department of General Thoracic Surgery, Okayama University Hospital Mikio Okazaki Department of General Thoracic Surgery, Okayama University Hospital Masaomi Yamane Department of General Thoracic Surgery, Okayama University Hospital Takahiro Oto Department of General Thoracic Surgery, Okayama University Hospital Susumu Kanazawa Department of Radiology, Okayama University Hospital Katsuyuki Kiura Department of Respiratory Medicine, Okayama University Hospital Shinichi Toyooka Department of General Thoracic Surgery, Okayama University Hospital Purpose Some long-term survivors after surgery for locally advanced non-small cell lung cancer (NSCLC) treated with induction chemoradiotherapy (trimodality treatment) develop chronic pulmonary aspergillosis (CPA). The aim of our study was to assess the characteristics and outcomes of CPA that develops after trimodality treatment. Methods We retrospectively reviewed the data of 187 NSCLC patients who underwent trimodality treatment between 1999 and 2018. Results Six male ever-smoker patients developed CPA. All 6 patients had undergone extended resection for NSCLC and had a history of either adjuvant chemotherapy (n = 3) or radiation pneumonitis (n = 4). Among the 4 patients with CPA localized in a single lung, 3 patients were treated surgically (completion pneumonectomy or cavernostomy) and 1 patient was treated with antifungal therapy alone. Both treatments led to the improved control of CPA. In contrast, patients with CPA in both lungs were not candidates for surgery, and died of CPA. The survival rates after trimodality treatment in the CPA group and the group without CPA were comparable (10-year survival rate, 50.0% vs. 57.6%, P = 0.59). Conclusion The early diagnosis of CPA localized in a single lung after NSCLC surgery is critical to improving control and survival in patients with CPA. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 3 2020 A Clinical Study Evaluating an Aspiration-type Semi-Automatic Cutting Biopsy Needle (SCIRO-1702) 209 214 EN Yusuke Matsui Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takao Hiraki Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshihiro Iguchi Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Jun Sakurai Center for Innovative Clinical Medicine Mayu Uka Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshihisa Masaoka Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hideo Gobara Division of Medical Informatics, Okayama University Hospital Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/59951 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. No potential conflict of interest relevant to this article was reported.

Hindawi Acta Medica Okayama 0896-4327 2020 2020 Impact of Right Ventricular Dilatation in Patients with Atrial Septal Defect 9509105 EN Rie Nakayama Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine,Dentistry and Pharmaceutical Sciences Yoichi Takaya Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine,Dentistry and Pharmaceutical Sciences Teiji Akagi Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine,Dentistry and Pharmaceutical Sciences Koji Nakagawa Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine,Dentistry and Pharmaceutical Sciences Nobuhisa Watanabe Division of Medical Support, Okayama University Hospital Saori Nobusada Division of Medical Support, Okayama University Hospital Toshi Matsushita Division of Medical Support, Okayama University Hospital Norihisa Toh Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine,Dentistry and Pharmaceutical Sciences Susumu Kanazawa Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine,Dentistry and Pharmaceutical Sciences Hiroshi Ito Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine,Dentistry and Pharmaceutical Sciences Objective. The aim of this study was to examine the relationship between right ventricular (RV) volume and exercise capacity in adult patients with atrial septal defect (ASD) and to determine the degree of RV dilatation for transcatheter ASD closure. Background. RV dilatation is an indication of transcatheter ASD closure; however, few studies have reported the clinical significance of RV dilatation. Methods. We enrolled 82 consecutive patients (mean age, 49 +/- 18 years; female, 68%) who underwent cardiac magnetic resonance imaging and symptom-limited cardiopulmonary exercise test before ASD closure. The relationship between RV volume and peak oxygen uptake (VO2) was evaluated. Results. The mean RV end-diastolic volume index was 108 +/- 27 ml/m(2) (range, 46 to 180 ml/m(2)). The mean peak VO2 was 24 +/- 7 ml/min/kg (range, 14 to 48 ml/min/kg), and the mean predicted peak VO2 was 90 +/- 23%. There were significant negative relationships of RV end-diastolic volume index with peak VO2 (r = -0.28, p<0.01) and predicted peak VO2 (r = -0.29, p<0.01). The cutoff value of RV end-diastolic volume index <80% of predicted peak VO2 was 120 ml/m(2), with the sensitivity of 49% and the specificity of 89%. Conclusions. There was a relationship between RV dilatation and exercise capacity in adult patients with ASD. RV end-diastolic volume index >= 120 ml/m(2) was related to the reduction in peak VO2. This criterion of RV dilatation may be valuable for the indication of transcatheter ASD closure. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 2045-7634 2020 Radiation pneumonitis after definitive concurrent chemoradiotherapy with cisplatin/docetaxel for non-small cell lung cancer: Analysis of dose-volume parameters EN Kuniaki Katsui Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Takeshi Ogata Department of Radiology, Iwakuni Clinical Center Kenta Watanabe Department of Radiology, Okayama University Hospital Norihisa Katayama Department of Radiology, Okayama University Hospital Masahiro Kuroda Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Katsuyuki Kiura Department of Allergy and Respiratory Medicine, Okayama University Hospital Takao Hiraki Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Yoshinobu Maeda Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Shinichi Toyooka Departments of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science 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. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 0360-3016 73 4 2009 Analysis of Factors Associated With Radiation-Induced Bronchiolitis Obliterans Organizing Pneumonia Syndrome After Breast-Conserving Therapy 1049 1054 EN Norihisa Katayama Department of Radiology, Okayama University Hospital Shuhei Sato Department of Radiology, Okayama University Hospital Kuniaki Katsui Department of Radiology, Okayama University Hospital Mitsuhiro Takemoto Department of Radiology, Okayama University Hospital Toshihide Tsuda Department of Radiology, Okayama University Hospital Atsushi Yoshida Department of Radiology, Okayama University Hospital Tsuneharu Morito Department of Radiology, Okayama University Hospital Tomio Nakagawa Department of Radiology, Okayama University Hospital Akifumi Mizutani Department of Radiology, Okayama University Hospital Takahiro Waki Department of Radiology, Okayama University Hospital Harutaka Niiya Department of Radiology, Okayama University Hospital Susumu Kanazawa Department of Radiology, Okayama University Hospital Purpose: To evaluate factors associated with radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome after breast-conserving therapy. Methods and materials: A total of 702 women with breast cancer who received radiotherapy after breast-conserving surgery at seven institutions between July 1995 and December 2006 were analyzed. In all patients, the whole breast was irradiated with two tangential photon beams. The criteria used for the diagnosis of radiation-induced BOOP syndrome were as follows: (1) radiotherapy to the breast within 12 months, (2) general and/or respiratory symptoms lasting for >or=2 weeks, (3) radiographs showing lung infiltration outside the radiation port, and (4) no evidence of a specific cause. Results: Radiation-induced BOOP syndrome was seen in 16 patients (2.3%). Eleven patients (68.8%) were administered steroids. The duration of steroid administration ranged from 1 week to 3.7 years (median, 1.1 years). Multivariate analysis revealed that age (>or=50 years; odds ratio [OR] 8.88; 95% confidence interval [CI] 1.16-67.76; p = 0.04) and concurrent endocrine therapy (OR 3.05; 95% CI 1.09-8.54; p = 0.03) were significantly associated with BOOP syndrome. Of the 161 patients whose age was >or=50 years and who received concurrent endocrine therapy, 10 (6.2%) developed BOOP syndrome. Conclusions: Age (>or=50 years) and concurrent endocrine therapy can promote the development of radiation-induced BOOP syndrome after breast-conserving therapy. Physicians should carefully follow patients who received breast-conserving therapy, especially those who are older than 50 years and received concurrent endocrine therapy during radiotherapy. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 2 2020 Association between Histological Types and Enhancement of Dynamic CT for Primary Lung Cancer 129 135 EN Shogo Fukuma Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takayoshi Shinya Department of Radiology, Okayama University Hospital Junichi Soh Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryuichiro Fukuhara Department of Pediatric Radiology, Okayama University Hospital Nanako Ogawa Department of Radiology, Okayama University Hospital Fumiyo Higaki Department of Radiology, Okayama City General Medical Center Takehiro Tanaka Department of Pathology, Okayama University Hospital Eiki Ichihara Department of Allergy and Respiratory Medicine, Okayama University Hospital Takao Hiraki Department of Radiology, Okayama University Hospital Shinichi Toyooka Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Department of Radiology, Okayama University Hospital Original Article 10.18926/AMO/58271 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. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 2 2020 The Diagnostic Capacity of Pre-treatment 18F-FDG PET/CT for Predicting the Extranodular Spread of Lymph Node Metastases in Patients with Oral Squamous Cell Carcinoma 123 128 EN Ryuichiro Fukuhara Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takayoshi Shinya Department of Radiology, Okayama Diagnostic Imaging Center, Okayama university Hospital Shogo Fukuma Department of Radiology, Okayama Diagnostic Imaging Center, Okayama university Hospital Nanako Ogawa Department of Radiology, Okayama Diagnostic Imaging Center, Okayama university Hospital Yoshihisa Masaoka Department of Radiology, Okayama Diagnostic Imaging Center, Okayama university Hospital Takehiro Tanaka Department of Pathology, Okayama Diagnostic Imaging Center, Okayama university Hospital Hidenori Marunaka Department of Otolaryngology-Head & Neck Surgery, Okayama Diagnostic Imaging Center, Okayama university Hospital Tadashi Arioka Department of Radiology, Okayama Diagnostic Imaging Center, Okayama university Hospital Takao Hiraki Department of Radiology, Okayama Diagnostic Imaging Center, Okayama university Hospital Mitsumasa Kaji Department of Radiology, Okayama Diagnostic Imaging Center, Okayama university Hospital Susumu Kanazawa Department of Radiology, Okayama Diagnostic Imaging Center, Okayama university Hospital Original Article 10.18926/AMO/58270 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. No potential conflict of interest relevant to this article was reported.

Hindawi Acta Medica Okayama 2314-6133 2020 2020 DV200 Index for Assessing RNA Integrity in Next-Generation Sequencing 9349132 EN Takehiro Matsubara Okayama University Hospital Biobank, Okayama University Hospital Junichi Soh Department of Surgery, Division of Thoracic Surgery, Kindai University Faculty of Medicine Mizuki Morita Department of Biomedical Informatics,Okayama University Graduate School of Interdisciplinary Science and Engineering in Health Systems Takahiro Uwabo Department of Biomedical Informatics,Okayama University Graduate School of Interdisciplinary Science and Engineering in Health Systems Shuta Tomida Department of Biobank, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine,Dentistry and Pharmaceutical Sciences Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinichi Toyooka Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine,Dentistry and Pharmaceutical Sciences Akira Hirasawa Department of Clinical Genomic Medicine, Okayama University Graduate School of Medicine,Dentistry and Pharmaceutical Sciences Poor quality of biological samples will result in an inaccurate analysis of next-generation sequencing (NGS). Therefore, methods to accurately evaluate sample integrity are needed. Among methods for evaluating RNA quality, the RNA integrity number equivalent (RINe) is widely used, whereas the DV200, which evaluates the percentage of fragments of >200 nucleotides, is also used as a quality assessment standard. In this study, we compared the RINe and DV200 RNA quality indexes to determine the most suitable RNA index for the NGS analysis. Seventy-one RNA samples were extracted from formalin-fixed paraffin-embedded tissue samples (n=30), fresh-frozen samples (n=25), or cell lines (n=16). After assessing RNA quality using the RINe and DV200, we prepared two kinds of stranded mRNA sequencing libraries. Finally, we calculated the correlation between each RNA quality index and the amount of library product (1(st) PCR product per input RNA). The DV200 measure showed stronger correlation with the amount of library product than the RINe (R2=0.8208 for the DV200 versus 0.6927 for the RINe). Receiver operating characteristic curve analyses revealed that the DV200 was the better marker for predicting efficient library production than the RINe using a threshold of >10 ng/ng for the amount of the 1(st) PCR product per input RNA (cutoff value for the RINe and DV200, 2.3 and 66.1%; area under the curve, 0.99 and 0.91; sensitivity, 82% and 92%; and specificity, 93% and 100%, respectively). Our results indicate that NGS libraries prepared using RNA samples with the DV200 value>66.1% exhibit greater sensitivity and specificity than those prepared with the RINe values>2.3. These findings suggest that the DV200 is superior to the RINe, especially for low-quality RNA, because it is a more consistent assessment of the amount of the 1(st) NGS library product per input. No potential conflict of interest relevant to this article was reported.

American Roentgen Ray Society Acta Medica Okayama 0361-803X 2020 Differentiation of Small (≤ 4 cm) Renal Masses on Multiphase Contrast-Enhanced CT by Deep Learning 1 8 EN Takashi Tanaka Department of Radiology, Okayama University Hospital Yong Huang Department of Medical Informatics, Okayama University Hospital Yohei Marukawa Department of Radiology, Okayama University Hospital Yuka Tsuboi Department of Radiology, Okayama University Hospital Yoshihisa Masaoka Department of Radiology, Okayama University Hospital Katsuhide Kojima Department of Radiology, Okayama University Hospital Toshihiro Iguchi Department of Radiology, Okayama University Hospital Takao Hiraki Department of Radiology, Okayama University Hospital Hideo Gobara Department of Radiology, Okayama University Hospital Hiroyuki Yanai Department of Radiology, Okayama University Hospital Yasutomo Nasu Department of Urology, Okayama University Hospital Susumu Kanazawa Department of Radiology, Okayama University Hospital 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 contrast-enhanced 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. No potential conflict of interest relevant to this article was reported.

Spandidos Publications Acta Medica Okayama 1791-2997 20 3 2019 Development of a novel method for visualizing restricted diffusion using subtraction of apparent diffusion coefficient values 2963 2969 EN Yuuki Yoshimura Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Masahiro Kuroda Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Irfan Sugianto Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Abdullah Khasawneh Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Babatunde O. Bamgbose Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kentaro Hamada Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Majd Barham Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nouha Tekiki Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Akira Kurozumi Central Division of Radiology, Okayama University Hospital Toshi Matsushita Central Division of Radiology, Okayama University Hospital Seiichiro Ohno Central Division of Radiology, Okayama University Hospital Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Junichi Asaumi Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences In order to visualize restricted diffusion, the present study developed a novel method called 'apparent diffusion coefficient (ADC) subtraction method (ASM)' and compared it with diffusion kurtosis imaging (DKI). The diffusion-weighted images of physiological saline, in addtion to bio-phatoms of low cell density and the highest cell density were obtained using two sequences with different effective diffusion times. Then, the calculated ADC values were subtracted. The mean values and standard deviations (SD) of the ADC values of physiological saline, low cell density and the highest cell density phantoms were 2.95 +/- 0.08x10(-3), 1.90 +/- 0.35x10(-3) and 0.79 +/- 0.05x10(-3) mm(2)/sec, respectively. The mean kurtosis values and SD of DKI were 0.04 +/- 0.01, 0.44 +/- 0.13 and 1.27 +/- 0.03, respectively. The ASM and SD values were 0.25 +/- 0.20x10(4), 0.51 +/- 0.41x10(4) and 4.80 +/- 4.51x10(4) (sec/mm(2))(2), respectively. Using bio-phantoms, the present study demonstrated that DKI exhibits restricted diffusion in the extracellular space. Similarly, ASM may reflect the extent of restricted diffusion in the extracellular space. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 1748-717X 14 1 2019 Dose distribution of intensity-modulated proton therapy with and without a multi-leaf collimator for the treatment of maxillary sinus cancer: a comparative effectiveness study. 209 EN Soichi Sugiyama Departments of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine Kuniaki Katsui Departments of Proton Beam Therapy, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine Yuki Tominaga Department of Radiation Technology, Tsuyama Chuo Hospital Takahiro Waki Department of Radiology, Tsuyama Chuo Hospital, Tusyama Norihisa Katayama Departments of Radiology, Okayama University Hospital Hidenobu Matsuzaki Departments of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital Shin Kariya Departments of Otolaryngology-Head and Neck Surgery, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine Masahiro Kuroda Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Kazunori Nishizaki Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Departments of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine BACKGROUND: Severe complications, such as eye damage and dysfunciton of salivary glands, have been reported after radiotherapy among patients with head and neck cancer. Complications such as visual impairment have also been reported after proton therapy with pencil beam scanning (PBS). In the case of PBS, collimation can sharpen the penumbra towards surrounding normal tissue in the low energy region of the proton beam. In the current study, we examined how much the dose to the normal tissue was reduced by when intensity-modulated proton therapy (IMPT) was performed using a multi-leaf collimator (MLC) for patients with maxillary sinus cancer. METHODS: Computed tomography findings of 26 consecutive patients who received photon therapy at Okayama University Hospital were used in this study. We compared D2% of the region of interest (ROI; ROI-D2%) and the mean dose of ROI (ROI-mean) with and without the use of an MLC. The organs at risk (OARs) were the posterior retina, lacrimal gland, eyeball, and parotid gland. IMPT was performed for all patients. The spot size was approximately 5-6 mm at the isocenter. The collimator margin was calculated by enlarging the maximum outline of the target from the beam's eye view and setting the margin to 6 mm. All plans were optimized with the same parameters. RESULTS: The mean of ROI-D2% for the ipsilateral optic nerve was significantly reduced by 0.48 Gy, and the mean of ROI-mean for the ipsilateral optic nerve was significantly reduced by 1.04 Gy. The mean of ROI-mean to the optic chiasm was significantly reduced by 0.70 Gy. The dose to most OARs and the planning at risk volumes were also reduced. CONCLUSIONS: Compared with the plan involving IMPT without an MLC, in the dose plan involving IMPT using an MLC for maxillary sinus cancer, the dose to the optic nerve and optic chiasm were significantly reduced, as measured by the ROI-D2% and the ROI-mean. These findings demonstrate that the use of an MLC during IMPT for maxillary sinus cancer may be useful for preserving vision and preventing complications. No potential conflict of interest relevant to this article was reported.

BMC Acta Medica Okayama 1471-2407 19 1 2019 Dose-volume parameters predict radiation pneumonitis after induction chemoradiotherapy followed by surgery for non-small cell lung cancer: a retrospective analysis 1144 EN Kuniaki Katsui Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Takeshi Ogata Department of Radiology, Iwakuni Clinical Center Kenta Watanabe Department of Radiology, Okayama University Hospital Norihisa Katayama Department of Radiology, Okayama University Hospital Junichi Soh Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine Masahiro Kuroda Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Katsuyuki Kiura Department of Allergy and Respiratory Medicine, Okayama University Hospital Yoshinobu Maeda Hematology, Oncology and Respiratory Medicine Shinichi Toyooka Department of General Thoracic Surgery and Breast and Endocrinological SurgeryOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Susumu Kanazawa Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science BACKGROUND: The relationship between lung dose-volume histogram (DVH) parameters and radiation pneumonitis (RP) associated with induction concurrent chemoradiotherapy (CCRT) followed by surgery in patients with non-small cell lung cancer (NSCLC) is unclear, particularly when concerning irradiation of the whole lung prior to resection. We performed this study to identify factors associated with grade ≥ 2 RP in such patients. METHODS: Patients who received induction CCRT (chemotherapy: cisplatin and docetaxel; radiotherapy: 46 Gy/23 fractions) between May 2003 and May 2017 were reviewed. The mean lung dose (MLD) and the percentage of the lung volume that received ≥5 Gy (V5) and ≥ 20 Gy (V20) were calculated. Factors associated with the development of grade ≥ 2 RP were analyzed. RESULTS: One hundred and eight patients were included in this study, 34 (31.5%) of whom experienced grade ≥ 2 RP. A V20 ≥ 21%, an MLD ≥10 Gy, and a lower lobe tumor location were significant predictors of grade ≥ 2 RP on univariate analysis (p = 0.007, 0.002, and 0.004, respectively). Moreover, an MLD ≥10 Gy and lower lobe location were significant predictors of grade ≥ 2 RP on multivariate analysis (p = 0.026 and 0.0043, respectively). The cumulative incidence rates of grade ≥ 2 RP at 6 months were 15.7 and 45.6% in patients with MLDs < 10 Gy and ≥ 10 Gy, respectively, and were 23.5 and 55.6% in patients with upper/middle lobe- vs. lower lobe-located tumors, respectively. CONCLUSIONS: MLD and lower lobe location were predictors of grade ≥ 2 RP in patients who received induction CCRT. It is necessary to reduce the MLD to the greatest extent possible to prevent the occurrence of this adverse event. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 1930-0433 14 6 2019 Imaging an intrapulmonary solitary fibrous tumor with CT and F-18 FDG PET/CT 755 758 EN Takayoshi Shinya Department of Pediatric Radiology, Okayama University Hospital Yoshihisa Masaoka Department of Radiology, Okayama University Hospital Motohiro Sando Department of Radiology, Okayama University Hospital Shin Tanabe Department of Radiology, Okayama University Hospital Soichiro Okamoto Department of Radiology, Okayama University Hospital Hiroki Ihara Department of Radiology, Okayama University Hospital Takehiro Tanaka Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinji Otani Department of General Thoracic Surgery, Okayama University Hospital Takao Hiraki Department of Radiology, Okayama University Hospital Susumu Kanazawa Department of Radiology, Okayama University Hospital 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. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 3 2019 Contrast-enhanced Computed Tomography-Guided Percutaneous Cryoablation of Renal Cell Carcinoma in a Renal Allograft: First Case in Asia 269 272 EN Ichiro Tsuboi Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Motoo Araki Hiroyasu Fujiwara Department of Radiology, Okayama University Hospital Toshihiro Iguchi Department of Radiology, Okayama University Hospital Takao Hiraki Department of Radiology, Okayama University Hospital Naoko Arichi Department of Urology, Shimane University, Faculty of Medicine Kasumi Kawamura Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Maruyama Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yosuke Mitsui Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takuya Sadahira Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Risa Kubota Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shingo Nishimura Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomoko Sako Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Atsushi Takamoto Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Koichiro Wada Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasuyuki Kobayashi Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toyohiko Watanabe Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroyuki Yanai Department of Pathology, Okayama University Hospital Masashi Kitagawa Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Katsuyuki Tanabe Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hitoshi Sugiyama Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Jun Wada Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroaki Shiina Department of Urology, Shimane University, Faculty of Medicine Susumu Kanazawa Department of Radiology, Okayama University Hospital Yasutomo Nasu Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/56871 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. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 71 2 2017 Outcome of Radiation Monotherapy for High-risk Patients with Stage I Esophageal Cancer 127 133 EN Yasuhiro Shirakawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuhiro Noma Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Naoaki Maeda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shunsuke Tanabe Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine,Dentistry and Pharmaceutical Sciences Shinji Kuroda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine,Dentistry and Pharmaceutical Sciences Shunsuke Kagawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine,Dentistry and Pharmaceutical Sciences Kuniaki Katsui Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Norihisa Katayama Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/54981 Currently, chemoradiation is the most widely used nonsurgical treatment for esophageal cancer. However, some patients, particularly the very elderly or those with severe vital organ dysfunction, face difficulty with the chemotherapy component. We therefore examined the outcome of radiation therapy (RT) alone for patients with esophageal cancer at our facility. Between January 2005 and December 2014, 84 patients underwent RT at our hospital, and 78 of these patients received concomitant chemotherapy. The remaining 6 patients underwent RT alone; these patients were considered to be high-risk and to have no lymph node metastasis (stage I). Five of them received irradiation up to a curative dose: 4 showed a complete response (CR) and 1 showed a partial response (PR). Of the patients exhibiting CR, 3 are currently living recurrence-free, whereas 1 patient underwent endoscopic submucosal dissection (ESD) as salvage therapy for local recurrence, with no subsequent recurrence. High-risk stage I esophageal cancer patients can be treated radically with RT alone under certain conditions. In the future, to broaden the indications for RT monotherapy to include some degree of advanced cancers, a novel concurrent therapy should be identified. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 71 2 2017 Diagnostic Value of Dual-time-point F-18 FDG PET/CT and Chest CT for the Prediction of Thymic Epithelial Neoplasms 105 112 EN Takayoshi Shinya Department of Radiology, Okayama University Hospital Takashi Tanaka Department of Radiology, Okayama University Hospital Junichi Soh Department General Thoracic Surgery, Okayama University Hospital Toshi Matsushita Department of Radiology, Okayama University Hospital Shuhei Sato Department of Radiology, Okayama University Hospital Shinichi Toyooka Department General Thoracic Surgery, Okayama University Hospital Tadashi Yoshino Department of Pathology, Okayama University Hospital Shinichiro Miyoshi Department General Thoracic Surgery, Okayama University Hospital Susumu Kanazawa Department of Radiology, Okayama University Hospital Original Article 10.18926/AMO/54978 We retrospectively assessed the dual-time-point (DTP) F-18 FDG PET/CT findings of thymic epithelial neoplasms (TENs) and investigated the diagnostic capacity of PET/CT compared to that of CT for predicting carcinoma. We calculated the ratio of the standardized uptake value of the tumor and that of the aortic arch (T/M ratio) for both the 90-min early scan and the 2-h delayed scan in 56 TEN patients. We used a multivariate logistic regression (MLR) analysis to estimate the CT features of carcinoma. We compared the diagnostic capacities of PET/CT and chest CT using receiver operating characteristic (ROC) analyses. The ROC curve revealed that the appropriate cut-off T/M ratio value for the highest accuracy was 2.39 with 75.0% accuracy. The area under the curve (AUC) was 0.855. The statistical analyses for DTP scans of 35 TEN patients demonstrated 74.3% accuracy and 0.838 AUC for the early scan versus 82.9% and 0.825 for the delayed scan. The MLR analysis indicated that mediastinal fat infiltration was a predictor of carcinoma. The ROC curve obtained for the model yielded an AUC of 0.853. Delayed scanning could improve the diagnostic capacity for carcinoma. The T/M ratio and mediastinal fat infiltration are predictive of carcinoma with moderate diagnostic accuracy. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 71 2 2017 Evaluation of Urinary Stone Composition and Differentiation between Urinary Stones and Phleboliths Using Single-source Dual-energy Computed Tomography 91 96 EN Nanako Ogawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shuhei Sato Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kentaro Ida Department of Radiologic Diagnosis and Interventional Radiology, Fukuyama City Hospital Katsuya Kato Department of Diagnostic Radiology, Kawasaki Hospital Yuichi Ariyoshi Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Koichiro Wada Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasutomo Nasu Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/54976 The aim of this study was to investigate the utility of single-source dual-energy computed tomography (SS-DECT) composition analysis in characterizing different types of urinary stones and differentiating them from phleboliths. This study included 29 patients with urinary stones who were scheduled for surgery. All patients were scanned, first using single-energy computed tomography acquisition and then DECT acquisition on SS-DECT. Dual-energy data were archived to a Gemstone spectral imaging (GSI) viewer (GE Healthcare, Milwaukee, WI, USA). Hounsfield units (HU) and effective atomic numbers (Zeff) were estimated using the GSI viewer. The results of dual-energy analysis were compared with the biochemical constitution of the stones. The chemical analysis determined that the stones included 32 calcium-based, 6 cystine and 1 struvite stone. Both HU and Zeff values were helpful in differentiating calcium-based stones from cystine and struvite stones and phleboliths. The Zeff values of phleboliths were significantly higher than those for struvite and cystine stones, whereas it was difficult to distinguish phleboliths from struvite and cystine stones using the HU values. Composition analysis using SS-DECT is helpful for distinguishing urinary stone types and discriminating phleboliths from urinary stones. Zeff values may be more useful than HU values for differentiating urinary stones from phleboliths. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 71 1 2017 Interfractional Seminal Vesicle Motion Relative to the Prostate Gland for Image-guided Radiotherapy for Prostate Cancer with/without Androgen Deprivation Therapy: A Retrospective Cohort Study 31 39 EN Takahiro Waki Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kuniaki Katsui Department of Radiology, Okayama University Hospital Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Okayama University Hospital Takeshi Ogata Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Norihisa Katayama Department of Radiology, Okayama University Hospital Mitsuhiro Takemoto Department of Radiology, Japanese Red Cross Society Himeji Hospital Yasutomo Nasu Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiromi Kumon Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/54823 We investigated differences in seminal vesicle (SV) length and interfractional SV motion relative to the prostate gland in prostate cancer patients. We compared 32 patients who received androgen deprivation therapy (ADT) before radiotherapy with 12 patients receiving radiotherapy alone at Okayama University Hospital in August 2008-July 2011. We examined the right and left SVs’ length and motion by computed tomography (CT) to determine the ADT’s effects and analyzed 347 CT scans in a multiple linear regression model. The ADT patients’ SV length was significantly shorter than the non-ADT patients’. The differences in right and left SV lengths between the ADT and non-ADT patients were 6.8 mm (95% CI 2.0-11.7 mm) and 7.2 mm (95% CI 3.1-11.3 mm) respectively in an adjusted regression model. SV motion did not differ between the ADT and non-ADT patients in terms of interfractional motion of the SV tips and the SVs’ center relative to the prostate gland. The ADT patients had significantly shorter SVs compared to the non-ADT patients, but no difference in SV motion was observed. SV interfractional motion should thus be compensated using the same planning margins, regardless of whether ADT is used. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 70 6 2016 Acute Bowel Injury due to Cryoablation for Renal Cell Carcinoma: Correlated Radiologic and Pathologic Findings 511 514 EN Hideo Gobara Department of Radiology,Okayama University Hospital Takao Hiraki Department of Radiology,Okayama University Hospital Toshihiro Iguchi Department of Radiology,Okayama University Hospital Hiroyasu Fujiwara Department of Radiology,Okayama University Hospital Takeshi Nagasaka Department of Gastroenterological Surgery, Okayama University Hospital Hiroyuki Kishimoto Department of Gastroenterological Surgery, Okayama University Hospital Takehiro Tanaka Department of Pathology, Okayama University Hospital Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Case Report 10.18926/AMO/54817 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. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 70 4 2016 Single Center Prospective Phase II Trial of CT-guided Radiofrequency Ablation for Pulmonary Metastases from Colorectal Cancer (SCIRO-1401) 317 321 EN Jun Sakurai Center for Innovative Clinical Medicine, Okayama University Hospital Yusuke Matsui Department of Radiology, Okayama University Hospital Takao Hiraki Department of Radiology, Okayama University Hospital Toshihiro Iguchi Department of Radiology, Okayama University Hospital Hiroyasu Fujiwara Department of Radiology, Okayama University Hospital Hideo Gobara Department of Radiology, Okayama University Hospital Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Okayama University Hospital Takeshi Nagasaka Department of Gastroenterological Surgery Transplant and Surgical Oncology, Okayama University Hospital Susumu Kanazawa Susumu Kanazawa Department of Radiology, Okayama University Hospital Clinical Study Protocols 10.18926/AMO/54512 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. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 70 4 2016 Safety of Percutaneous Cryoablation in Patients with Painful Bone and Soft Tissue Tumors: A Single Center Prospective Study (SCIRO-1502) 303 306 EN Toshihiro Iguchi Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Jun Sakurai Center for Innovative Clinical Medicine, Okayama University Hospital Takao Hiraki Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hideo Gobara Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroyasu Fujiwara Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yusuke Matsui Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshihisa Masaoka Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Clinical Study Protocols 10.18926/AMO/54509 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. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 70 4 2016 A Case of Focal Bone Marrow Reconversion Mimicking Bone Metastasis: The Value of 111Indium Chloride 285 289 EN Takashi Tanaka Department of Radiology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hideo Gobara Department of Radiology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryota Inai Department of Radiology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshihiro Iguchi Department of Radiology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Akihiro Tada Department of Radiology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shuhei Sato Department of Radiology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroyuki Yanai Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Department of Radiology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/54505 We present a case of a 66-year-old man with esophageal carcinoma. 18Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for evaluating distant metastasis and staging revealed 18F-FDG uptake in the third lumbar vertebra and other vertebrae. Magnetic resonance imaging could not differentiate bone metastases from benign bone lesions. We considered the possibility of bone marrow reconversion. 111Indium chloride (111In-Cl3) scintigraphy with single-photon emission computed tomography/computed tomography (SPECT/CT) revealed erythroid bone marrow components in the bone lesions. The diagnosis of bone marrow reconversion was pathologically confirmed by a bone biopsy of the third lumbar vertebra. The patient underwent esophagectomy and has remained disease-free in the 2 years since. To the best of our knowledge, this is the first report to describe the usefulness of 111In-Cl3 with SPECT/CT for the diagnosis of bone marrow reconversion. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 70 3 2016 Computed Tomography-guided Radiofrequency Ablation for Subdiaphragm Hepatocellular Carcinoma: Safety and Efficacy of Inducing an Artificial Pneumothorax 189 195 EN Hiroyasu Fujiwara Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Yasuaki Arai Diagnostic Radiology Division, National Cancer Center Hospital Hiroaki Ishii Diagnostic Radiology Division, National Cancer Center Hospital Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Original Article 10.18926/AMO/54418 We retrospectively evaluated the safety and efficacy of artificial pneumothorax induction to perform computed tomography (CT)-guided radiofrequency ablation (RFA) for sub-diaphragm hepatocellular carcinomas (HCCs). From June 2008 to October 2010 at our institution, 19 HCCs (16 patients) were treated using CT-guided RFA after artificial pneumothorax induction. A 23-G needle was inserted into the liver surface at a site of 2 connected pleurae without lung tissue. After a small amount of air was injected, the pleural space widened, creating a small pneumothorax. Additional air was insufflated via a newly inserted 18-G cannula to raise the lung away from the planned puncture line for RFA. The electrode was then advanced transthoracically. Ablation was performed using a cool-tip electrode with manual impedance control mode. The injected air was then aspirated as much as possible. Artificial pneumothorax was successfully induced in all cases. The average total volume of injected air in each case was 238ml. No artificial pneumothorax-related complication occurred; lung injury occurred in one case during RF electrode insertion. No local progression occurred during follow-up. Recurring HCCs were observed in eight patients. Artificial pneumothorax induction is safe and effective for CT-guided RFA of sub-diaphragm HCCs, which are difficult to locate on US. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 69 4 2015 Comparison of Field-in-Field Radiotherapy with Conformal Radiotherapy for Unilateral Cervical Malignant Lymphoma 189 195 EN Mako Yamashita Norihisa Katayama Takahiro Waki Kuniaki Katsui Kengo Himei Mitsuhiro Takemoto Susumu Kanazawa Original Article 10.18926/AMO/53554 This study compared field-in-field (FIF) radiotherapy with conformal radiotherapy with physical wedges for the treatment of unilateral cervical malignant lymphoma. Two treatment plans, the FIF technique and conformal RT, were generated for each of 32 patients with unilateral cervical malignant lymphoma. To compare the 2 treatment plans, dose-volume histograms of the planning target volume (PTV), the thyroid, submandibular gland, carotid artery, mucosa, spinal cord, and surrounding normal tissue, and monitor unit (MU) were analyzed. The FIF technique showed significant reduction in the mean dose of thyroid, submandibular gland, carotid artery and mucosa, the maximum dose of the spinal cord and PTV, and the volume receiving＞107% of the prescribed dose of surrounding normal tissue (p＜0.001). In addition, there were gains in the homogeneity index of the PTV for FIF. Furthermore, the total MU was also lower for the FIF technique than for the wedge technique (p＜0.001). Compared with the wedge technique, the FIF technique improved the dose homogeneity of the PTV, reduced the dose to normal structures, and was associated with fewer MUs in the treatment of patients with cervical malignant lymphoma. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 127 2 2015 陽子線治療 155 157 EN Kuniaki Katsui Tomoaki Okimoto Susumu Kanazawa No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 67 6 2013 In Vitro Assessment of Factors Affecting the Apparent Diffusion Coefficient of Jurkat Cells Using Bio-phantoms 359 367 EN Kazunori Katashima Masahiro Kuroda Masakazu Ashida Takanori Sasaki Takehito Taguchi Hidenobu Matsuzaki Jun Murakami Yoshinobu Yanagi Miki Hisatomi Marina Hara Hirokazu Kato Yuichi Ohmura Tomoki Kobayashi Susumu Kanazawa Sosuke Harada Mitsuhiro Takemoto Seiichiro Ohno Seiichi Mimura Junichi Asaumi Original Article 10.18926/AMO/52009 It is well known that many tumor tissues show lower apparent diffusion coefficient (ADC) values, and that several factors are involved in the reduction of ADC values. The aim of this study was to clarify how much each factor contributes to decreases in ADC values. We investigate the roles of cell density, extracellular space, intracellular factors, apoptosis and necrosis in ADC values using bio-phantoms. The ADC values of bio-phantoms, in which Jurkat cells were encapsulated by gellan gum, were measured by a 1.5-Tesla magnetic resonance imaging device with constant diffusion time of 30sec. Heating at 42℃ was used to induce apoptosis while heating at 48℃ was used to induce necrosis. Cell death after heating was evaluated by flow cytometric analysis and electron microscopy. The ADC values of bio-phantoms including non-heated cells decreased linearly with increases in cell density, and showed a steep decline when the distance between cells became less than 3μm. The analysis of ADC values of cells after destruction of cellular structures by sonication suggested that approximately two-thirds of the ADC values of cells originate from their cellular structures. The ADC values of bio-phantoms including necrotic cells increased while those including apoptotic cells decreased. This study quantitatively clarified the role of the cellular factors and the extracellular space in determining the ADC values produced by tumor cells. The intermediate diffusion time of 30msec might be optimal to distinguish between apoptosis and necrosis. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 57 5 2003 Percutaneous sclerotherapy for venous malformations using polidocanol under fluoroscopy. 227 234 EN Hidefumi Mimura Susumu Kanazawa Kotaro Yasui Hiroyasu Fujiwara Tsuyoshi Hyodo Takashi Mukai Shuichi Dendo Toshihiro Iguchi Takao Hiraki Isao Koshima Yoshio Hiraki Article 10.18926/AMO/51909 This retrospective study evaluated the safety and efficacy of using polidocanol with X-ray fluoroscopy for percutaneous sclerotherapy of venous malformations of the limbs, head, and neck. The subjects were 16 of 18 patients who presented to our department with venous malformations. Two patients were excluded because they were unlikely to benefit from the treatment. Of the 16 included in the study, 1 could not be treated because of inaccessibility, and another was lost to follow-up. Among the 14 cases that we were able to follow-up, 11 cases had had pain as their primary symptom. Following treatment, this symptom remained unchanged in 1 patient, was improved in 4, and had disappeared in 6; however, there was a recurrence of pain for 3 of these patients. Two patients had sought treatment for cosmetic purposes; following treatment, the lesion disappeared in one and showed a significant reduction in the other. The remaining patient presented with a primary symptom of mouth bleeding, which disappeared following treatment. There were no critical complications. Percutaneous sclerotherapy of venous malformations using polidocanol is safe and effective, and permits repeat treatments. The efficacy is especially good for resolving pain, and complications are minor. It is desirable to use fluoroscopy for these procedures No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 125 3 2013 IVR 263 265 EN Susumu Kanazawa No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 67 3 2013 Association between Mammographic Breast Density and Lifestyle in Japanese Women 145 151 EN Setsuko Ishihara Naruto Taira Kensuke Kawasaki Youichi Ishibe Taeko Mizoo Keiko Nishiyama Takayuki Iwamoto Tomohiro Nogami Takayuki Motoki Tadahiko Shien Junji Matsuoka Hiroyoshi Doihara Yoshifumi Komoike Shuhei Sato Susumu Kanazawa Original Article 10.18926/AMO/50407 A high mammographic breast density is considered to be a risk factor for breast cancer. However, only a small number of studies on the association between breast density and lifestyle have been performed. A cross-sectional study was performed using a survey with 29 questions on life history and lifestyle. The breast density on mammography was classified into 4 categories following the BI-RADS criteria. The subjects were 522 women with no medical history of breast cancer. The mean age was 53.3 years old. On multivariate analysis, only BMI was a significant factor determining breast density in premenopausal women (parameter estimate, －0.403;p value, 0.0005), and the density decreased as BMI rose. In postmenopausal women, BMI (parameter estimate, －0.196;p value, 0.0143) and number of deliveries (parameter estimate, －0.388;p value, 0.0186) were significant factors determining breast density;breast density decreased as BMI and number of deliveries increased. Only BMI and number of deliveries were identified as factors significantly influencing breast density. BMI was inversely correlated with breast density before and after menopause, whereas the influence of number of deliveries on breast density was significant only in postmenopausal women in their 50 and 60s. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 67 2 2013 The Maximum Standardized Uptake Value Is More Reliable Than Size Measurement in Early Follow-up to Evaluate Potential Pulmonary Malignancies Following Radiofrequency Ablation 105 112 EN Aierken Alafate Takayoshi Shinya Yoshihiro Okumura Shuhei Sato Takao Hiraki Hiroaki Ishii Hideo Gobara Katsuya Kato Toshiyoshi Fujiwara Shinichiro Miyoshi Mitsumasa Kaji Susumu Kanazawa Original Article 10.18926/AMO/49669 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)/computed 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. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 66 6 2012 Endometrial Polyps:MR Imaging Features 475 485 EN Soichiro Hase Akihito Mitsumori Ryota Inai Mitsuhiro Takemoto Shinichiro Matsubara Nobuo Akamatsu Masayoshi Fujisawa Ikuo Joja Shuhei Sato Susumu Kanazawa Original Article 10.18926/AMO/49044 The purpose of this study is to evaluate the diagnostic usefulness of magnetic resonance imaging (MRI) characteristics of endometrial polyps in order to differentiate them from other endometrial lesions. MRI was retrospectively reviewed in 40 patients with pathologically proven endometrial polyps. Special attention was paid to the sizes, shapes, margins, internal structures, signal intensities, and post-contrast enhancement patterns. A central fibrous core, intratumoral cysts, and hemorrhage were seen in 30 (75%), 22 (55%), and 14 (35%) patients, respectively. The predominant signal intensity of the lesions showed iso-to slightly low signal intensity relative to the endometrium on T2-weighted images in 36 (90%), low signal intensity on diffusion-weighted images in 32 (80%), and strong or moderate enhancement on enhanced T1-weighted images in 28 patients (70%), respectively. In 32 (80%) patients, the endometrial polyps showed global or partial early enhancement. On dynamic study, rapid enhancement with a persistent strong enhancement pattern was seen in 17 (42.5%) and a gradually increasing enhancement pattern was seen in 17 patients (42.5%). These MRI features can be helpful to distinguish the endometrial polyps from various other endometrial lesions. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 66 3 2012 In Vitro Assessment of Factors Affecting the Apparent Diffusion Coefficient of Ramos Cells Using Bio-phantoms 263 270 EN Takanori Sasaki Masahiro Kuroda Kazunori Katashima Masakazu Ashida Hidenobu Matsuzaki Junichi Asaumi Jun Murakami Seiichiro Ohno Hirokazu Kato Susumu Kanazawa Original Article 10.18926/AMO/48566 The roles of cell density, extracellular space, intracellular factors, and apoptosis induced by the molecularly targeted drug rituximab on the apparent diffusion coefficient (ADC) values were investigated using bio-phantoms. In these bio-phantoms, Ramos cells (a human Burkittｾs lymphoma cell line) were encapsulated in gellan gum. The ADC values decreased linearly with the increase in cell density, and declined steeply when the extracellular space became less than 4 μm. The analysis of ADC values after destruction of the cellular membrane by sonication indicated that approximately 65% of the ADC values of normal cells originate from the cell structures made of membranes and that the remaining 35% originate from intracellular components. Microparticles, defined as particles smaller than the normal cells, increased in number after rituximab treatments, migrated to the extracellular space and significantly decreased the ADC values of bio-phantoms during apoptosis. An in vitro study using bio-phantoms was conducted to quantitatively clarify the roles of cellular factors and of extracellular space in determining the ADC values yielded by tumor cells and the mechanism by which apoptosis changes those values. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 66 3 2012 Visualization of Stent Lumen in MR Imaging: Relationship with Stent Design and RF Direction 203 211 EN Seiichiro Ohno Takashi Harimoto Miyuki Hirosue Masahiro Miyai Kengo Hattori Masahiro Kuroda Susumu Kanazawa Keiji Inamura Hirokazu Kato Original Article 10.18926/AMO/48559 Magnetic resonance imaging (MRI) visualization of metallic stent lumens is possible if the stent structure counteracts eddy currents in the lumen induced by the radio frequency magnetic field, B1. To examine the effectiveness of various stent designs in counteracting eddy currents, we anchored eight copper stent models and 2 commercially available nickel-titanium alloy (Nitinol) stents in a gel phantom, perpendicular or parallel to the direction of B1. A mesh stent lumen showed hypointensity irrespective of its alignment relative to B1. A solenoid stent lumen showed hypointensity with the stent axis parallel to B1, but it had the same signal intensity as outside the lumen when perpendicular to B1. A Moebius stent lumen showed no signal reduction, irrespective of alignment relative to B1. Lumens of the commercially available stents showed hypointensity regardless of alignment relative to B1. Computer simulation revealed that the signal intensities of the stents corresponded to magnetic flux densities of B1 in the stents, which are modified by the structure of the stent. While in vivo MRI viewing of a Moebius stent lumen is likely possible regardless of axis alignment, inherent structural weakness may be problematic. As a more practical choice, the solenoid stent is easier to manufacture and generates no hypointensive signal when the axis is parallel to B0. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 65 6 2011 The Usefulness of Pre-Radiofrequency Ablation SUVmax in 18F-FDG PET/CT to Predict the Risk of a Local Recurrence of Malignant Lung Tumors after Lung Radiofrequency Ablation 395 402 EN Sosuke Harada Shuhei Sato Etsuji Suzuki Yoshihiro Okumura Takao Hiraki Hideo Gobara Hidefumi Mimura Susumu Kanazawa Mitsumasa Kaji Toshiyoshi Fujiwara Original Article 10.18926/AMO/47265 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 (SUVmax). 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 SUVmax. 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 SUVmax and recurrence in a crude model, we adjusted for some factors. Tumors with higher SUVmax 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 10mm in diameter. This study demonstrated the pre-RFA SUVmax in PET/CT may be a prognostic factor for local recurrence of malignant lung tumors. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 65 5 2011 A Case of Renal Transcatheter Arterial Embolization with Ethanol in Autosomal Dominant Polycystic Kidney Disease for Volume Reduction 347 351 EN Takashi Mukai Hidefumi Mimura Hideo Gobara Mitsuharu Shimizu Harutaka Niiya Susumu Kanazawa Case Report 10.18926/AMO/47018 We report herein the case of a 76-year-old woman with autosomal dominant polycystic kidney disease (ADPKD) and chronic renal failure resulting in intractable abdominal distension and anorexia. Computed tomography (CT) showed enlarged and cystic kidneys. We performed transcatheter arterial embolization (TAE) for renal arteries with ethanol. Absolute ethanol with iodinated contrast medium or Lipiodol was delivered into both renal arteries. The patient's low-grade fever subsided in 5 days, and no other complication occurred. The sensation of abdominal distension diminished approximately 1 month after embolization. A progressive decrease in kidney size was observed soon after embolization. The percentage of the decrement of kidney size was approximately 50% after 17 months. These results indicate that renal TAE with ethanol is a safe, cost-effective, and minimally invasive technique to reduce kidney size in symptomatic ADPKD patients. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 65 5 2011 Radiofrequency Ablation of Lung Cancer at Okayama University Hospital: A Review of 10 Years of Experience 287 297 EN Takao Hiraki Hideo Gobara Hidefumi Mimura Shinichi Toyooka Hiroyasu Fujiwara Kotaro Yasui Yoshifumi Sano Toshihiro Iguchi Jun Sakurai Nobuhisa Tajiri Takashi Mukai Yusuke Matsui Susumu Kanazawa Review 10.18926/AMO/47010 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. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 65 4 2011 Preoperative Graft Volume Assessment with 3D-CT Volumetry in Living-Donor Lobar Lung Transplantations 265 268 EN Katsuhide Kojima Katsuya Kato Takahiro Oto Toshiharu Mitsuhashi Takayoshi Shinya Tetsuro Sei Yoshihiro Okumura Shuhei Sato Shinichiro Miyoshi Susumu Kanazawa Original Article 10.18926/AMO/46852 To determine the effectiveness of living-donor lobar lung transplantation (LDLLT), it is necessary to predict the recipient's postoperative lung function. Traditionally, Date's formula, also called the segmental ratio, has used the number of lung segments to estimate the forced vital capacity (FVC) of grafts in LDLLT. To provide a more precise estimate of graft FVC, we calculated the volumes of the lower lobe and total lung using three-dimensional computed tomography (3D-CT) and the volume ratio between them. We calculated the volume ratio in 52 donors and tested the difference between the segmental volume ratios with a one-tailed t-test. We also calculated the predicted graft FVC in 21 LDLLTs using the segmental ratio pFVC(c) and the volume ratio pFVC(v), and then found the Pearson's correlation coefficients for both pFVC(c) and pFVC(v) with the recipients' actual FVC (rFVC) measured spirometrically 6 months after surgery. Significant differences were found between the segmental ratio and the average volume ratio for both sides (right, p＝0.03;left, p＝0.0003). Both pFVC(c) and pFVC(v) correlated significantly with rFVC at 6 months after surgery (p＝0.007 and 0.006). Both the conventional and the volumetric methods provided FVC predictions that correlated significantly with measured postoperative FVC. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 123 2 2011 ベクレルとシーベルト 155 157 EN Susumu Kanazawa No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 65 1 2011 Hepatic Arterial Infusion Chemotherapy Prior to Standard Systemic Chemotherapy in Patients with Highly Advanced Unresectable Liver Metastases from Colorectal Cancer: A Report of Three Patients 49 53 EN Toshihiro Iguchi Hitoshi Idani Shinya Asami Hisashi Endo Yoshitaka Inaba Yasuaki Arai Susumu Kanazawa Case Report 10.18926/AMO/43830 We administered hepatic arterial infusion chemotherapy (HAIC) prior to FOLFOX to three patients with unresectable liver metastases from colorectal cancer. The patients' disease state was found to be highly advanced based on both computed tomography findings and liver function tests. The treatment strategy included an initial administration of HAIC to control liver metastases and improve liver function in order to facilitate the subsequent safe administration of FOLFOX without drug loss. As the HAIC regimen, 1,000mg/m2 of 5-FU was administered weekly by continuous 5-h infusion after performing laboratory investigations through an implanted port-catheter system. After 3 HAIC cycles administered over 3 consecutive weeks, the mean alkaline phosphatase levels decreased from 969.3IU/l to 422IU/l due to shrinkage of the liver metastases. Thereafter, FOLFOX without drug loss could be safely initiated for all patients. Two patients succumbed 488 and 333 days after HAIC was initiated;the third patient is still alive and has been followed-up for 1215 days. The combined use of HAIC and standard systemic chemotherapy could be a feasible and efficacious treatment in highly advanced cases of liver dysfunction. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 122 3 2010 脈絡膜血管腫に対する放射線治療 219 223 EN Sosuke Harada Mitsuhiro Takemoto Koutarou Yoshio Katsuhide Kojima Norihisa Katayama Kuniaki Katsui Masahiro Kuroda Toshihiko Matsuo Susumu Kanazawa PURPOSE: Circumscribed choroidal hemangioma is an uncommon, benign vascular tumor that typically appears in the posterior pole of the eye. Visual acuity loss typically results from its exudation, followed by serous retinal detachment. The purpose of the study was to evaluate the efficacy and the safety of external beam irradiation in treating circumscribed choroidal hemangioma. METHODS: We treated 4 eyes of 4 patients with circumscribed choroidal hemangioma with external beam irradiation at Okayama University Hospital from 2002 to 2009. A total absorbed dose of 20 Gy (beam energy, 4, 10 MV) was applied to each of the 4 patients. Each patient received a single 2-Gy daily fraction for five consecutive days in a week, for two consecutive weeks. RESULTS: In all cases, the retinal detachment showed complete resolution within 8 to 48 days after treatment. A decrease in tumor thickness was observed in all cases except one in which the follow-up period was rather short (3.7 months). The visual acuity improved in all 4 eyes. No eyes showed deterioration of visual acuity. During follow-up periods of 3.7 months to 58.5 months, there were no signs of radiation-induced cataract, retinopathy or optic neuropathy. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 64 3 2010 Infant Hip Joint Diagnostic Support System Based on Clinical Manifestations in X-ray Images 189 196 EN Mitsugi Honda Seizaburo Arita Shigeru Mitani Yoshihiro Takeda Toshifumi Ozaki Keiji Inamura Susumu Kanazawa Original Article 10.18926/AMO/40011 Plain X-ray radiography is frequently used for the diagnosis of developmental dislocation of the hip (DDH). The aim of this study was to construct a diagnostic support system for DDH based on clinical findings obtained from the X-ray images of 154 female infants with confirmed diagnoses made by orthopedists. The data for these subjects were divided into 2 groups. The Min-Max method of nonlinear analysis was applied to the data from Group 1 to construct the diagnostic support system based on the measurement of 4 items in X-ray images:the outward displacement rate, upward displacement rate, OE angle, and alpha angle. This system was then applied to the data from Group 2, and the results were compared between the 2 groups to verify the reliability of the system. We obtained good results that matched the confirmed diagnoses of orthopedists with an accuracy of 85.9%. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 61 3 2007 Radiofrequency ablation followed by radiation therapy for large primary lung tumors 177 180 EN Takashi Mukai Hidefumi Mimura Hideo Gobara Mitsuhiro Takemoto Kengo Himei Takao Hiraki Soichiro Hase Hiroyasu Fujiwara Toshihiro Iguchi Nobuhisa Tajiri Jun Sakurai Kotaro Yasui Yoshifumi Sano Hiroshi Date Susumu Kanazawa Case Report 10.18926/AMO/32906 We report the clinical experience of radiofrequency ablation followed by radiation therapy for large primary lung tumors. Two patients with large primary lung tumors were treated with combined radiofrequency ablation and radiation therapy, and good local control was observed. Combined radiofrequency ablation and radiation therapy that involves minimally invasive techniques appears to be promising for the treatment of large lung tumors. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 61 5 2007 Evaluation of Esophageal Varices by Multidetector-row CT: Correlation with Endoscopic ‘Red Color Sign’ 247 254 EN Hirofumi Mifune Shiro Akaki Kentaro Ida Tetsuro Sei Susumu Kanazawa Hiroyuki Okada Original Article 10.18926/AMO/32894 To evaluate the ability of multidetector-row CT (MDCT) to predict a risk of hemorrhage in patients with esophageal varices, a total of 40 MDCT scans were performed in 29 patients who had been diagnosed with esophageal varices by conventional upper gastrointestinal tract endoscopy. In 11 patients, MDCT was performed both before and after endoscopic injection sclerotherapy (EIS). Endoscopically, the red color sign (RC sign) was present in 28 scans. Of the 11 patients who underwent EIS, the RC sign disappeared after EIS in 9. The MDCT scans were obtained in the arterial, portal, and equilibrial phases, and the portal phase images were used in this study. Subsequently, the extent of esophageal varices was categorized into four MDCT scores. The variceal score, the maximum short axis of the varices, and the presence of palisade vein dilatation obtained from MDCT had significant correlation with endoscopic variceal forms, and the presence and severity of RC sign, respectively (p<0.01). All cases with a maximum minor axis of more than 4 mm showed positive RC sign. MDCT was useful in the evaluation of esophageal varices for predicting a risk of hemorrhage. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 61 2 2007 Resolution of pulmonary multiplanar reconstruction images from 0.5-mm theoretical isotropic data: a fundamental study using an inflated and fixed lung specimen. 63 69 EN Daisuke Maki Masashi Takahashi Noritoshi Ushio Ryutaro Takazakura Norihisa Nitta Kiyoshi Murata Susumu Kanazawa Original Article 10.18926/AMO/32886 The aim of the present study was to define the resolution of multiplanar reconstruction (MPR) of the lung from "theoretical isotropic data." Using inflated and fixed lung specimens of the pig placed in the chest wall phantom, 0.5-mm isotropic data were obtained with 2 different helical pitches: 1:7 (high-quality mode) or 1:13, (high-speed mode), and 2 different tube currents: 250 mAs (high-tube-current mode) or 100 mAs (low-tube-current mode), with or without overlapping reconstruction. MPRs were created from these axial data. The diameter of the smallest visible pulmonary artery and bronchi of these CT images were measured on the corresponding slices of the specimen. The high-speed and low-tube-current mode significantly degraded the image quality due to increased noise. The smallest visible pulmonary artery and bronchus resolved on MPRs from axial-spiral data with 0.5-mm collimation were approximately 100 micrometer and 1,000 micrometer in diameter, respectively. In conclusion, helical pitch and tube current influence the resolution of MPR of the lung. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 54 3 2000 Effects of medical education on attitudes towards mental illness among medical students: a five-year follow-up study. 127 132 EN Yoshio Mino Nobufumi Yasuda Susumu Kanazawa Shimpei Inoue Article 10.18926/AMO/32304 In order to clarify the effects of medical education on attitudes towards mental illness among medical students, a follow-up study was conducted. All 100 students entering Kochi Medical School in 1988 were subjects. The initial questionnaire survey was conducted in 1988, and followed up in 1993. Response rate was 69% in the initial survey, and 83% in the follow-up study. By the time of the follow-up, all of the students had completed their medical education, including courses in psychiatry and mental health. Results were as follows: At the follow-up study, 1) a significantly higher percentage of students replied that they accepted the mentally ill as co-workers; 2) significantly favorable changes were observed in attitudes towards psychiatric services; 3) optimism about the effectiveness of treatment for mental illness at an early stage and prevention of mental illness had decreased; and 4) no change was observed in attitudes toward human rights of the mentally ill, except in the case of one item stating that the mentally ill should not have children in order to avoid hereditary handicaps, with which a lower percentage agreed. Conclusively, medical education can play an important role in attitudes towards mental illness. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 58 1 2004 Functional evaluation of lung by Xe-133 lung ventilation scintigraphy before and after lung volume reduction surgery (LVRS) in patients with pulmonary emphysema. 7 15 EN Taichi Kurose Yoshihiro Okumura Shuhei Sato Yasuhiro Yamamoto Shiro Akaki Yoshihiro Takeda Susumu Kanazawa Akio Ando Hiroshi Date Nobuyoshi Shimizu Yoshio Hiraki Article 10.18926/AMO/32116 We evaluated the respiratory functions of patients with pulmonary emphysema who underwent lung volume reduction surgery (LVRS) by the mean transit time (MTT) with Xe-133 lung ventilation scintigraphy, forced expiration volume in 1 sec (FEV1.0), residual volume (RV), distance walked in 6 min (6-min walk), and the Hugh-Jones classification (H-J classification) before and after LVRS. In 69 patients with pulmonary emphysema (62 men, 7 women; age range, 47-75 years; mean age, 65.4 years +/- 6.1, preoperative H-J classification, III (two were II)-V) who underwent LVRS, all preoperative and postoperative parameters (MTT 3 weeks after LVRS and the others 3 months after LVRS) were judged statistically by the Wilcoxon signed-ranks test and Odds ratio. Every postoperative parameter was improved with a significant difference (P < 0.05) compared to preoperative parameters. MTT at 3 weeks after LVRS was not associated with %FEV1.0 and the H-J classification at 3 months after LVRS, but was associated with RV and a 6-min walk at 3 months after LVRS. MTT was useful for the clinical evalution of aerobic capability after LVRS. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 58 5 2004 Intrapulmonary lymph nodes: thin-section CT findings, pathological findings, and CT differential diagnosis from pulmonary metastatic nodules. 235 240 EN Tsuyoshi Hyodo Susumu Kanazawa Shuichi Dendo Keita Kobayashi Hirohide Hayashi Yoshihiro Kouno Mamoru Fujishima Yoshio Hiraki Article 10.18926/AMO/32102 We compared the thin-section CT findings of 11 intrapulmonary lymph nodes with pathological findings and evaluated the possibility of CT scan differential diagnosis from pulmonary metastatic nodules. First, we retrospectively reviewed CT scan and pathological findings of intrapulmonary lymph nodes. The median size of these nodules was 6.2 mm. The nodules appeared round (n=3) or angular (n=8) in shape with a sharp border, and they were found below the level of the carina. The median distance from the nearest pleural surface was 4.6 mm, and 3 of the 11 nodules were attached to the pleura. On thin-section CT scan, linear densities extending from the intrapulmonary lymph nodes were frequently visualized, and were pathologically proven to be ectatic lymphoid channels. We then compared the thin-section CT findings of 8 metastatic nodules less than 1 cm in diameter with those of the 11 intrapulmonary lymph nodes. The median size of these nodules was 6.8 mm, and the median distance from the nearest pleural surface was 16 mm. All nodules appeared round in shape. None of the nodules had linear densities extending from the nodules. The linear densities on thin-section CT scan may be the most useful characteristic of intrapulmonary lymph nodes, when differential diagnosis from metastatic nodules is necessary. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 58 2 2004 Differentiation of thyroid nodules using Tl-201 scintigraphy quantitative analysis and fine-needle aspiration biopsy. 75 83 EN Yasuhiro Yamamoto Yoshihiro Okumura Shuhei Sato Kumi Maki Takashi Mukai Hirofumi Mifune Shiro Akaki Yoshihiro Takeda Susumu Kanazawa Yoshio Hiraki Article 10.18926/AMO/32098 We studied the differentiation of thyroid nodules using fine-needle aspiration biopsy (FNA) and Tl-201 scintigraphy quantitative analysis. One-hundred and thirty-one thyroid nodules were examined: 83 follicular lesions (58 benign and 25 malignant lesions) and 48 non-follicular lesions (8 benign and 40 malignant lesions). During Tl-201 scintigraphy examinations, an early and a delayed image were acquired 10 and 120 min after an intravenous injection, respectively. The T/N ratio (counts of nodular lesion/counts of contralateral normal thyroid tissue) of each image was calculated quantitatively. We assessed the ability of the Tl-201 scintigraphy and of the FNA analysis to differentiate benign and malignant lesions and determined the cut-off levels for the assays. For the follicular lesions, the area under the ROC (Receiver Operating Characteristic) curve (Az) for the Tl-201 scintigraphy data was greater than that for the FNA data. For the non-follicular lesions, the Az for the FNA data was greater than that for the Tl-201 scintigraphy data. We set cut-off levels at 1.370 for follicular lesions, and 1.070 for non-follicular lesions. The sensitivity and specificity were 76% and 82.7% for follicular lesions, and 90% and 87.5% for non-follicular lesions, respectively. The overall accuracy of the analysis was 84.0%. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 58 2 2004 Hepatic infarction following abdominal interventional procedures. 97 106 EN Hiroyasu Fujiwara Susumu Kanazawa Takao Hiraki Hidefumi Mimura Kotaro Yasui Shiro Akaki Takahito Yagi Yoshio Naomoto Noriaki Tanaka Yoshio Hiraki Article 10.18926/AMO/32095 To clarify the incidence, background, and progress of hepatic infarction following interventional procedures, cases of hepatic infarction following interventional procedures at our department during the last decade were identified by reviewing the clinical records of 1982 abdominal angiography and interventional procedures and records of abdominal CT. Nine episodes (0.5%) in 8 patients were identified as hepatic infarction following an interventional procedure. Five episodes were preceded by embolization of the hepatic or celiac artery at emergency angiography for postoperative bleeding with hemorrhagic shock. Three episodes followed the elected interventional procedure for hepatocellular carcinoma, and the remaining episode occurred after 12 months of chemoinfusion through an indwelling catheter in the hepatic artery and portal vein. Hepatic arterial occlusion in all episodes and portal venous flow abnormality in 5 episodes were observed on angiography. Four patients whose liver function was initially impaired died of hepatic infarction, although the extent of the disease on CT did not appear to be related to the mortality. Multiple risk factors, including arterial insufficiency, were observed in each patient. The incidence of hepatic infarction following interventional procedures in this series was low but sometimes fatal, and occurred most frequently in emergency embolization in hemorrhagic shock. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 55 5 2001 Recanalization 24 months after endovascular repair of a large internal iliac artery aneurysm with use of stent-graft. 315 318 EN Kotaro Yasui Susumu Kanazawa Hidefumi Mimura Shuichi Dendo Yoshio Hiraki Hiroyuki Irie Shunji Sano Article 10.18926/AMO/32016 An 83-year-old man with a large internal iliac artery aneurysm (IIAA) was treated with the use of stent-graft, suggesting successful results at 3, 6, and 12 months after treatment. However, 24-month follow-up computed tomography showed minor peripheral opacification of the IIAA. The patient underwent surgical endoaneurysmorrhaphy. No previous report of long-term recanalization of a satisfactorily thrombosed iliac artery aneurysm at 2 years or more after stent-grafting has been previously reported. Further follow-up studies need to be performed on the present procedure before anyone can confidently recommend it in regard to its long-term safety. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 59 3 2005 Diagnostic capabilities of I-131, TI-201, and Tc-99m-MIBI scintigraphy for metastatic differentiated thyroid carcinoma after total thyroidectomy. 99 107 EN Shunji Fujie Yoshihiro Okumura Shuhei Sato Shiro Akaki Kuniaki Katsui Kengo Himei Mitsuhiro Takemoto Susumu Kanazawa Article 10.18926/AMO/31983 We investigated the diagnostic capabilities of I-131, Tl-201, and Tc-99m-MIBI (hexakis-2-methoxyisobutyl- isonitrile) scintigraphy for thyroid cancer metastases after total thyroidectomy over the entire body and for every locus before and after thyroid bed ablation. After total thyroidectomy of thyroid cancer, 36 cases were subjected to I-131 treatment 64 times. They consisted of 17 men and 19 women with 31 papillary carcinomas and 5 follicular carcinomas. Their ages were 22--75(an average of 60.5+/-12.3) years. I-131 scintigraphy(I-131), Tl-201 scintigraphy(Tl-201), and Tc-99m- MIBI scintigraphy (Tc-99m-MIBI) were performed. We defined the metastases as those cases in which serum thyroglobulin (Tg)increased significantly or in which we were able to prove the lesions on CT (computed tomography), MRI (magnetic resonance imaging) or bone scintigram. Three radiology medical specialists visually evaluated each scintigram and calculated the sensitivity, specificity, and likelihood ratio. For whole-body sensitivity, both Tl-201 and Tc-99m-MIBI were high before ablation and I-131 was high after ablation. Before ablation, the negative likelihood ratio was less than 0.1 for Tl-201 and Tc-99m-MIBI, while the positive likelihood ratio was more than 10 for Tl-201. After ablation, the positive likelihood ratio for I-131, Tl-201, and Tc-99m-MIBI was more than 10. The sensitivity of the mediastinum was appropriate, except for I-131 before ablation, and the sensitivity of the lung before and after ablation was inferior for either tracer. The specificity of the cervix for I-131 before ablation was markedly deteriorated, but it increased after ablation. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 59 5 2005 Hepatic outflow obstruction created by balloon occlusion of the hepatic vein: induced hepatic hemodynamic changes and the therapeutic applications of hepatic venous occlusion with a balloon catheter in interventional radiology. 171 178 EN Takao Hiraki Susumu Kanazawa Letter to the Editor 10.18926/AMO/31975 Hepatic outflow obstruction created by balloon occlusion of the hepatic vein induces characteristic angiographic findings in the occluded area: prolonged enhancement on hepatogram followed by reversed portal opacification on the hepatic arteriogram and perfusion defect on the arterial portogram. The following induced hepatic hemodynamic changes are suggested: hepatic arterial flow increases, and the portal vein acts as a draining vein with slow reversed flow. These unique hemodynamic changes enhance the effect of hepatic interventional therapies. In transcatheter arterial infusion, increasing hepatic arterial flow and absence of portal inflow can bring about a high concentration of drugs, the presence of which is greatly protracted due to outflow blockage. In transcatheter arterial chemoembolization, reversed portal flow can allow portal embolization in addition to arterial embolization. In microwave coagulation therapy and radiofrequency ablation therapy, decreasing portal flow can cause larger areas of coagulation. Further, the technique of hepatic venous occlusion has potential therapeutic applications. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 63 3 2009 Infusion of Hypertonic Saline into the Lung Parenchyma during Radiofrequency Ablation of the Lungs with Multitined Expandable Electrodes:Results Using a Porcine Model 137 144 EN Tatsuhiko Iishi Takao Hiraki Hidefumi Mimura Hideo Gobara Taichi Kurose Hiroyasu Fujiwara Jun Sakurai Hiroyuki Yanai Tadashi Yoshino Susumu Kanazawa Original Article 10.18926/AMO/31848 The present study was performed to clarify the effect of hypertonic saline infusion into the lung parenchyma on radiofrequency ablation (RFA) of the lungs. A total of 20 ablation zones were created in 3 pigs. The ablation zones were divided into 3 groups. Group 1 (n6) consisted of ablation zones created by applying smaller radiofrequency (RF) power without saline infusion;group 2 (n5) zones were created by applying greater RF power without saline infusion;and group 3 (n9) zones were created by applying greater RF power with saline infusion. The techniques of saline infusion included administration of hypertonic saline 1ml before RFA, followed by continuous administration at a rate of 1ml/min during the first 2min after the initiation of RFA. The ablation parameters and coagulation necrosis volumes were compared among the groups. Group 3 had a tendency toward smaller mean impedance than group 1 (p0.059) and group 2 (p0.053). Group 3 showed significantly longer RF application time than group 2 (p0.004) and significantly greater maximum RF power than group 1 (p0.001) and group 2 (p0.004). Group 3 showed significantly larger coagulation necrosis volume (mean, 1,421mm3) than group 2 (mean, 858mm3, p0.039) and had a tendency toward larger necrosis volume than group 1 (mean, 878mm3, p0.077). Although this small study had limited statistical power, hypertonic saline infusion during RFA appeared to enlarge coagulation necrosis of the lung parenchyma. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 39 3 1985 Comparative study of the work load between one-man buses and two-man buses. 207 215 EN Mitsuo Ueno Takeo Ohta Shingo Nakagiri Takanori Ogawa Shunzo Nakao Toyotake Arisawa Yoshio Mino Ryosei Kodera Susumu Kanazawa Kouichi Oyama Katsumi Nakase Shigeki Koda Hideyasu Aoyama Article 10.18926/AMO/31527 The differences in physiological and safety conditions of one-man buses and two-man buses were examined from the view point of occupational fatigue. This survey consisted of a work load study which included a time study, study of subsidiary behavior, auditory task, memory test, Galvanic Skin Response (GSR) and physiological function tests and a self-administered questionnaire which involved items concerning safety and subjective fatigue complaints. The visual and postural restrictions in the one-man bus were greater than in the two-man bus. The mental capacity of the one-man bus drivers was found to be less. Greater mental fatigue and stress were observed in the one-man bus. More subjective fatigue complaints were observed in the one-man bus. More cases of near accidents were observed in the one-man bus. From these results it was concluded that the one-man bus caused bus drivers a greater mental and physical work load. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 62 1 2008 Iodine-125 Seed Implantation (Permanent Brachytherapy) for Clinically Localized Prostate Cancer 9 13 EN Shin Ebara Yoshihisa Katayama Ryuta Tanimoto Kohei Edamura Hiroyuki Nose Daisuke Manabe Tomoko Kobayashi Yasuyuki Kobayashi Makoto Kobuke Mitsuhiro Takemoto Takeshi Saika Yasutomo Nasu Susumu Kanazawa Hiromi Kumon Original Article 10.18926/AMO/30986 From January 2004 to March 2007, 308 patients with clinically localized prostate cancer were treated using iodine-125 (125I) seed implantation (permanent brachytherapy) at Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences. We evaluated the treatment’s effi cacy and morbidity in 300 prostate cancer patients who were followed up for more than 1 month after brachytherapy. Based on the National Comprehensive Cancer Network (NCCN) guidelines, patients with a prostate volume of less than 40 ml in transrectal ultrasound imaging were classifi ed as low or intermediate risk. The median patient age was 67 years (range 50 to 79 years), the median prostate-specific antigen (PSA) value before biopsy was 6.95 ng/ml (range 1.13 to 24.7 ng/ml), and the median prostate volume was 24.33 ml (range 9.3 to 41.76 ml). The median follow-up was 18 months (range 1 to 36 months) and the PSA levels decreased in almost all patients after brachytherapy. Although 194 of 300 patients (64.7%) complained of diffi culty in urination, pollakisuria/urgency, miction pain, and/or urinary incontinence, all of which might be associated with radiation prostatitis during the fi rst month after brachytherapy, these symptoms gradually improved. 125I seed implantation brachytherapy is safe and eff ective for localized prostate cancer within short-term follow up. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 62 3 2008 Basic Study of Susceptibility-Weighted Imaging at 1.5T 159 168 EN Toshi Matsushita Daigo Anami Tadashi Arioka Seiji Inoue Yusuke Kariya Masako Fujimoto Kentaro Ida Nobuya Sasai Mitsumasa Kaji Susumu Kanazawa Ikuo Joja Original Article 10.18926/AMO/30978 With the aim of sequence optimization in susceptibility-weighted imaging (SWI), 2 image acquisition parameters (slice thickness and matrix size) and 2 image processing conditions (number of slices per minimum intensity projection (MIP) and Sliding Window) were investigated using a 1.5-T magnetic resonance imaging (MRI) system. The subjects were 12 healthy volunteers and the target region for scanning was the whole brain. Informed consent was obtained from all subjects. First, susceptibility-weighted images were acquired with various slice thicknesses from 1mm to 5mm and various matrix sizes from 256x256 to 512x512, and the images were assessed in terms of the contrast-to-noise ratio (CNR) and were also visually evaluated by three radiologists. Then, the number of slices per MIP and the usefulness of the Sliding Window were investigated. In the study of the optimal slice thickness and matrix size, the results of visual evaluation suggested that a slice thickness of 3mm and a matrix size of 448x448 are optimal, while the results of evaluation based on CNR were not significant. As regards the image processing conditions, the results suggested that the number of slices per MIP should be set to a minimum value of 2 and that the use of Sliding Window is effective. The present study provides useful reference data for optimizing SWI sequences. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 60 2 2006 Effects of radiofrequency ablation on individual renal function: assessment by technetium-99m mercaptoacetyltriglycine renal scintigraphy. 85 91 EN Takashi Mukai Shuhei Sato Toshihiro Iguchi Hidefumi Mimura Kotaro Yasui Hideo Gobara Takashi Saika Yasutomo Nasu Hiromi Kumon Susumu Kanazawa Article 10.18926/AMO/30731 We quantitatively evaluated total and individual renal function by technetium-99m mercaptoacetyltriglycine (Tc-99m MAG3) renal scintigraphy before and after radiofrequency ablation (RFA) of renal tumors. Eleven patients who underwent Tc-99m MAG3 renal scintigraphy 1 week before and after RFA were evaluated (7 men and 4 women ; age range : 23-83 years ; mean age : 60.6 years). Five patients had solitary kidneys, and five had normally or minimally functioning contralateral kidneys. One patient had a renal cell carcinoma in the contralateral kidney. One patient with a solitary kidney underwent RFA a second time for a residual tumor. In patients with a solitary kidney, MAG3 clearance decreased after 5 of 6 RFAs, and in patients with a normally functioning contralateral kidney, MAG3 clearance decreased after 4 of 5 RFAs, but no significant differences were observed between before and after treatments. In addition to the total MAG3 clearance, the split MAG3 clearance was evaluated in patients with a normally functioning contralateral kidney. MAG3 clearance decreased in 4 of 5 treated kidneys, while it adversely increased in the contralateral kidneys after 4 of 5 RFAs. No significant differences, however, were observed between before and after treatments. The results of our study revealed no significant differences in sCr, BUN, CCr, or MAG3 clearance between pre- and post-RFA values. These results support data regarding the functional impact and safety of renal RFA in published reports. We evaluated total and individual renal function quantitatively using Tc-99m MAG3 renal scintigraphy before and after treatment. This scintigraphy was very useful in assessing the effects of RFA on renal function. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 60 4 2006 Cerebral perfusion MR imaging using FAIR-HASTE in chronic carotid occlusive disease: comparison with dynamic susceptibility contrast-perfusion MR imaging. 215 221 EN Kentaro Ida Shiro Akaki Tetsuro Sei Masatoshi Tsunoda Susumu Kanazawa Article 10.18926/AMO/30714 To determine the efficacy of flow-sensitive alternating inversion recovery using half-Fourier single-shot turbo spin-echo (FAIR-HASTE) in detecting cerebral hypoperfusion in chronic carotid occlusive disease, we subjected 12 patients with various degrees of cervical internal carotid artery stenoses and/or occlusion (Stenosis group) and 24 volunteers (Normal group) to FAIR-HASTE. In addition, 10 out of 12 patients in the Stenosis group underwent dynamic susceptibility contrast-perfusion magnetic resonance imaging (DSC-pMRI) before and after revascularization in the dominantly affected side. The absolute asymmetry indexes (AIs) of both cerebral hemispheres in the Normal and Stenosis groups were compared in FAIR-HASTE. In addition, the AIs were compared with those in the Stenosis group before and after revascularization in both FAIR-HASTE and regional cerebral blood flow (rCBF), calculated with DSC-pMRI. A statistically significant difference was recognized between the AIs in the Normal and Stenosis groups (AI = 2.25 +- 1.92, 8.09 +- 4.60, respectively ; p < 0.0001). Furthermore, in the Stenosis group the AIs on both FAIR-HASTE (8.88 +- 4.93, 2.22 +- 1.79, respectively ; p = 0.0003) and rCBF (7.13 +- 3.57, 1.25 +- 1.33, respectively ; p = 0.0003) significantly decreased after revascularization. In the Stenosis group, before revascularization, signal intensity on both FAIR-HASTE and rCBF had a tendency to be lower in the dominantly affected side. FAIR-HASTE imaging was useful in the detection and evaluation of cerebral hypoperfusion in chronic occlusive carotid disease. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 41 5 2005 Investigation of AC loss of permanent magnet of SPM motor considering hysteresis and eddy-current losses 1964 1967 EN A. Fukuma Susumu Kanazawa Daisuke Miyagi Norio Takahashi NdFeB sintered magnets are widely used in rotating electrical machines. In order to develop an efficient rotating machine, it is important to estimate ac loss of the permanent magnet of rotor precisely. In this paper, the ac losses of the permanent magnet of IEEJ model (surface permanent-magnet motor model) are examined by using the three-dimensional finite-element method taking into account the newly measured hysteresis losses of permanent magnet. The result shows that we should consider not only the eddy-current loss but also the hysteresis loss, when the frequency of ac field due to a slot ripple is of the order of several hundred hertz. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 122 1 2010 血管腫・血管奇形に対するinterventional radiology 55 59 EN Hidefumi Mimura Hiroyasu Fujiwara Takao Hiraki Hideo Gobara Kentaro Shibamoto Yoshihiro Kimata Toshifumi Ozaki Satoru Sasaki Susumu Kanazawa No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 121 3 2009 高精度放射線治療 215 218 EN Kuniaki Katsui Mitsuhiro Takemoto Susumu Kanazawa No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 98 1-2 1986 集団検診より見た腹部超音波検査の評価 ―びまん性肝疾患と胆石について― 163 176 EN Susumu Kanazawa Four hundred thirty-two middle-aged to elderly adults were examined by means of real-time ultrasonography as a mass screening method for liver and gallbladder diseases. Among them, 36 cases of diffuse liver disease and 22 cases of gallstones were detected. The results of the ultrasonic examinations were compared with the data obtained from blood laboratory examinations of hepatic function and lipid metabolism as well as with certain questionnaires on the history of such diseases, etc. Although some of the cases diagnosed as diffuse liver disease by ultrasonography showed abnormalities in the blood laboratory examinations, others showed normal data. Most of them were found to have a hsitory of liver disease, however. Ultrasonography revealed morphological changes in the liver due to chronic diffuse liver damage occurring in the inactive phase when blood laboratory data were normal. The significance of ultrasonic mass screening for liver disease lies its ability to reveal cases of morphologically changed livers whether they show abnormalities in blood laboratory examinations or not. As most cases of liver cancer have a hsitory of diffuse liver disease, it may be important to detect cases of diffuse liver disease by means of both ultrasonography and blood laboratory examination. Cases diagnosed as gallstones by ultrasonography did not have a definite tendency to show any abnormality in the blood laboratory examinations or have a history of gallbladder disease or clinical symptoms. Consequently, most of them could be designated as "silent gallstones" by ultrasonography, a very effective means of discovering them. As gallstones are suspected to be one of the decisive factors of gallbladder cancer, their early detection may be important in preventing it. Ultrasonic mass screening examinations are considered a reliable screening method for diffuse liver disease and gallstones. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 120 3 2008 XV 放射線治療 313 320 EN Mitsuhiro Takemoto Norihisa Katayama Kuniaki Katsui Susumu Kanazawa No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 116 3 2005 肺悪性腫瘍のラジオ波治療 245 250 EN No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 118 2 2006 非触知乳癌におけるVATSマーカーを用いたエコーガイド下マーキングの有用性 127 129 EN Junji Matsuoka Yoko Tabuchi Mitsuya Ito Ryoko Ono Takako Imada Hiroyosi Matsukawa Takayuki Motoki Yoshio Naomoto Susumu Kanazawa A preoperative tumor guiding system for nonpalpable breast cancer using a VATS guiding needle (Hakko Co., Ltd., Tokyo Japan) was reported. It was easy to introduce the guiding needle into breast cancers smaller than 1cm under ultrasonographic observation. Neither bleeding nor infection was experienced. Wound management was easy and painless. This guiding system is very useful for locating and managing nonpalpable breast cancers even in outpatient settings. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 118 2 2006 気管冷却下に施行した縦隔リンパ節転移に対するラジオ波焼灼療法 105 108 EN No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 118 2 2006 岡山画像診断センターの設立とその役割 (http://www.okayama-dic.or.jp) 93 98 EN No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 1986 集団検診より見た腹部超音波検査の評価びまん性肝疾患と胆石について EN No potential conflict of interest relevant to this article was reported.