The Japanese Society of Interventional RadiologyActa Medica Okayama2432-0935102025Is Saline Sealing of Needle Tract Effective to Prevent Pneumothorax after Computed Tomography-guided Lung Biopsy?e2025-0068ENSoichiroOkamotoDepartment of Radiology, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKojiTomitaDepartment of Radiology, Okayama University HospitalKazuakiMunetomoDepartment of Radiology, Okayama University HospitalNoriyukiUmakoshiDepartment of Radiology, Okayama University HospitalToshiharuMitsuhashiCenter for Innovative Clinical Medicine, Medical Development Field, Okayama UniversityToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityPurpose: To evaluate the efficacy of needle tract sealing using normal saline instillation for decreasing the risk of pneumothorax after computed tomography-guided lung biopsy.<br>
Material and Methods: This retrospective, single-institution study included 391 computed tomography-guided lung biopsies performed by 12 operators between January 2022 and October 2024. After exclusion, 298 biopsies were analyzed by comparing the saline seal (n = 138) and control (n = 160) groups. A 17/18-gauge or 19/20-gauge coaxial biopsy system was used, and tract sealing was performed by instilling 1-5 mL of normal saline during the withdrawal of the introducer needle in the saline seal group; tract sealing was not performed in the control group. After 1:1 propensity score matching was performed to balance baseline characteristics, the incidences of pneumothorax and chest tube placement were compared between the two groups using Fisher's exact test.<br>
Results: After propensity score matching, 108 pairs (mean lesion size: 17 mm) were well balanced. The incidence of pneumothorax did not differ significantly between the control and saline seal groups (50.0% vs. 60.2%, respectively; p = 0.171). Similarly, the incidence of chest tube placement was not significantly different between the two groups (7.4% vs. 13.0%, respectively; p = 0.260).<br>
Conclusions: According to the propensity score-matched analysis, normal saline instillation for tract sealing did not significantly reduce the incidence of pneumothorax or chest tube placement. In our cohort, which had a high prevalence of small lesions, saline sealing alone may be insufficient to reduce post-biopsy pneumothorax risk. Hence, combined strategies require further investigation.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7962025MRI Images of a Case of Adenocarcinoma, Human Papillomavirus-Independent, Mesonephric Type, of the Uterine Cervix463468ENYudaiAsanoDepartment of Radiology, Okayama University HospitalChikaNishiharaDepartment of Radiology, Okayama University HospitalTakahiroKitayamaDepartment of Radiology, Okayama University HospitalNanakoOkawaDepartment of Radiology, Okayama University HospitalSatokoMakimotoDepartment of Radiology, Okayama University HospitalFumiyoHigakiDepartment of Radiology, Okayama University HospitalKatsuhideKojimaDepartment of Radiology, Okayama University HospitalHanakoSugiharaDepartment of Obstetrics and Gynecology, Okayama University HospitalNaoyukiIdaDepartment of Obstetrics and Gynecology, Okayama University HospitalHiroyukiYanaiDepartment of Pathology, Okayama University HospitalTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityCase Report10.18926/AMO/69850We present a case of a woman in her 70s who was diagnosed with mesonephric adenocarcinoma of the uterine cervix, following biopsy and surgery. Preoperative MRI revealed a 7-cm, well-defined circumferential cervical mass with left lateral wall predominance, bulging into the uterine cavity and vagina. The lesion showed intermediate signal intensity on T2-weighted images, diffusion restriction, and early contrast enhancement weaker than that of the myometrium, followed by washout on contrast-enhanced imaging. The circumferential growth pattern with the lateral wall predominance and its imaging characteristics may suggest this rare entity be routinely included in the differential diagnosis of cervical cancers.No potential conflict of interest relevant to this article was reported.The Japanese Society of Interventional RadiologyActa Medica Okayama2432-0935102025Optimal Virtual-target Definition for Detecting Feeding Arteries of Renal Cell Carcinoma Using Automated Feeder-detection Softwaree2025-0034ENSoichiroOkamotoDepartment of Radiology, Medical Development Field, Okayama UniversityYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakahiroKawabataDepartment of Radiology, Tsuyama Chuo HospitalKojiTomitaDepartment of Radiology, Medical Development Field, Okayama UniversityKazuakiMunetomoDepartment of Radiology, Medical Development Field, Okayama UniversityNoriyukiUmakoshiDepartment of Radiology, Medical Development Field, Okayama UniversityFumiyoHigakiDepartment of Radiology, Medical Development Field, Okayama UniversityToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityPurpose: To determine the optimal virtual-target definition for detecting renal cell carcinoma feeders using transarterial computed tomography angiography with automated feeder-detection software.<br>
Material and Methods: This retrospective study included 17 patients with 17 renal cell carcinomas who underwent transarterial ethiodized-oil marking before cryoablation. Tumor feeders were automatically detected on transarterial renal computed tomography angiography images using the automated feeder-detection software with three virtual-target definitions: small (ellipsoidal area maximized within the tumor contour), medium (ellipsoidal area covering the entire tumor with a minimal peripheral margin), and large (ellipsoidal area including the tumor and a 5-mm peripheral margin). The detected feeders were classified as true or false positives according to the findings of selective renal arteriography, by consensus of two interventional radiologists. Feeder-detection sensitivity and the mean number of false-positive feeders per tumor were calculated for each virtual-target definition.<br>
Results: For 17 tumors, 25 feeding arteries were identified on the arteriography. The feeder-detection sensitivity of the software was 80.0% (20/25), 88.0% (22/25), and 48.0% (12/25) for small, medium, and large virtual targets, respectively. The mean } standard deviation number of false-positive feeders per tumor was 0.82 } 1.3, 1.41 } 1.1, and 2.82 } 1.6 when using small, medium, and large virtual-target definitions, respectively.<br>
Conclusions: The detection rate of renal cell carcinoma feeders with the automated feeder-detection software varies according to the virtual-target definition. Using a medium virtual target, covering the entire tumor with a minimal peripheral margin, may provide the highest sensitivity and an acceptable number of false-positive feeders.No potential conflict of interest relevant to this article was reported.Japanese Society for Lymphoreticular Tissue ResearchActa Medica Okayama1346-42806442024Computed tomography findings of idiopathic multicentric Castleman disease subtypes292296ENToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityAsamiNishikoriDepartment of Molecular Hematopathology, Okayama University Graduate School of Health SciencesYasuharuSatoDepartment of Molecular Hematopathology, Okayama University Graduate School of Health SciencesMidori FilizNishimuraDepartment of Molecular Hematopathology, Okayama University Graduate School of Health SciencesNorikoIwakiDepartment of Hematology, National Cancer Center HospitalKatsuhideKojimaDepartment of Radiology, Okayama University HospitalTakashiAsaharaDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityFumioOtsukaDepartment of General Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYoshinobuMaedaDepartment of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityThis study retrospectively evaluated the computed tomography (CT) findings of idiopathic multicentric Castleman disease (iMCD) at a single center and compared the CT findings of iMCD-TAFRO with those of iMCD-non-TAFRO. CT images obtained within 30 days before diagnostic confirmation were reviewed for 20 patients with iMCD (8 men and 12 women, mean age 52.8 } 12.3 years, range 25–74 years). Twelve patients were diagnosed with iMCD-TAFRO, five with iMCD-idiopathic plasmacytic lymphadenopathy, and three with iMCD-not otherwise specified. CT images revealed anasarca and lymphadenopathy in all 20 patients. The iMCD-TAFRO group showed significantly higher frequencies of ascites (100% vs. 37.5%, P = 0.004), gallbladder wall edema (75.0% vs. 12.5%, P = 0.020), periportal collar (91.7% vs. 25.0%, P = 0.004), and anterior mediastinal lesions (non-mass-forming infiltrative lesions) (66.7% vs. 12.5%, P = 0.028). Para-aortic edema tended to be more frequent in patients with the iMCD-TAFRO group (83.3% vs. 37.5%, P = 0.062), while the absence of anterior mediastinal lesions tended to be more frequent in the iMCD-non-TAFRO group (16.7% vs. 62.5%, P = 0.062). These CT findings may have clinical implications for improving the accuracy and speed of iMCD diagnosis and differentiating iMCD-TAFRO from other subtypes.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1867-10714382025Overview of task shifting guidelines in Japan: from radiologists to radiological technologists12611268ENAkiKidoDepartment of Radiology, Toyama University HospitalKazukoOhnoDepartment of Radiological Technology, Kyoto University of Medial ScienceKeiYamadaDepartment of Radiology, Kyoto Prefectural University of MedicineKoichiroYamakadoDepartment of Radiology, The Hospital of Hyogo College of MedicineTakaoHirakiDepartment of Radiology, Okayama UniversityTakashiMizowakiDepartment of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto UniversityNorikoAidaDepartment of Diagnostic Radiology, Yokohama City University Graduate School of MedicineNorikoOyama-ManabeDepartment of Radiology, Jichi Medical University Saitama Medical CenterNaokiKodamaDepartment of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and WelfareKatsuhikoUedaDepartment of Radiological Sciences, School of Health Sciences at Narita, International University of Health and WelfareShigekiAokiHealth Data Science, Department of Radiology/Data Science, Graduate School of Medicine, Juntendo UniversityNoriyukiTomiyamaDepartment of Radiology, Osaka University Graduate School of MedicineAs one of the key pillars of work style reform for physicians, task shifting and sharing from radiologists to radiological technologists has been considered. In May 2021, the Radiological Technologists Act was amended, allowing for the expansion of several duties. Alongside these legal and regulatory changes, a notice from Ministry of Health, Labour and Welfare was issued, highlighting tasks to be particularly promoted under the current system prior to the amendment of the Radiological Technologists Act. These amendments authorize radiological technologists to perform advanced and specialized tasks, such as securing venous access for contrast agent administration, which require significantly higher skill levels than their traditional roles. However, the amended legislation did not include specific guidelines, rules, or considerations for the practical implementation of these new duties in daily medical practice, especially from the perspectives of patient safety and quality of care. To address this, the Japan Radiological Society, the Japanese College of Radiology, and the Japan Association of Radiological Technologists collaborated with other related societies to develop guidelines on five key topics:-Guidelines for Safe Conduct of CT/MRI Contrast-Enhanced Examinations: Considering the expanded scope of practice for radiological technologists. -Guidelines for Safe Conduct of Nuclear Medicine Examinations: Aligned with the expanded responsibilities of radiological technologists. -Guidelines for Clinical application of Image-Guided Radiation Therapy (IGRT). -Guidelines for Safe Conduct of Angiography and Interventional Radiology (IR): Adapted for the expanded roles of radiological technologists. -Guidelines for Reporting Findings of STAT Imaging: Addressing urgent conditions with potential impact on life prognosis.No potential conflict of interest relevant to this article was reported.Japanese Society of Internal MedicineActa Medica Okayama0918-291863232024Successful Treatment for Life Threatening Recurrent Non-traumatic Rectus Sheath Hematoma in a Case with Microscopic Polyangiitis with Rapidly Progressive Glomerulonephritis32433248ENHiroyukiNakanohDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesHidemiTakeuchiDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesShihoMorimotoDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesYuyaTerajimaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesShugoOkamotoDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesYasuhiroOnishiDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesKeikoTanakaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesTakayukiKatsuyamaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesKenjiTsujiDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesYoshinoriMatsumotoDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesKatsuyukiTanabeDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesHiroshiMorinagaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesMayuUkaDepartment of Radiology, Okayama University HospitalKojiTomitaDepartment of Radiology, Okayama University HospitalHaruhito A.UchidaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityJunWadaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesA 68-year-old woman was admitted to our hospital because of a rapid progression of renal dysfunction with positive myeloperoxidase antineutrophil cytoplasmic antibody and was diagnosed with rapidly progressive glomerulonephritis associated with microscopic polyangiitis (MPA). Severe right rectus sheath hematoma (RSH) bleeding from the inferior epigastric artery developed after starting hemodialysis, which required 4 transarterial embolizations due to recurrent bleeding. After additional treatment with methylprednisolone pulse therapy and rituximab, no rebleeding occurred. Although the giant hematoma reached the pelvis, it shrank spontaneously without any intervention. Nontraumatic RSH should therefore be considered when treating patients with multiple risk factors.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1867-10714322024Evaluation of a novel central venous access port for direct catheter insertion without a peel-away sheath282289ENToshihiroIguchiDepartment of Radiology, Okayama University HospitalTakahiroKawabataDepartment of Radiology, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKojiTomitaDepartment of Radiology, Okayama University HospitalMayuUkaDepartment of Radiology, Okayama University HospitalNoriyukiUmakoshiDepartment of Radiology, Okayama University HospitalSoichiroOkamotoDepartment of Radiology, Okayama University HospitalKazuakiMunetomoDepartment of Radiology, Okayama University HospitalTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityPurpose This study retrospectively evaluated the feasibility and safety of implanting a newly developed central venous access port (CV-port) that allows catheter insertion into a vein without the use of a peel-away sheath, with a focus on its potential to minimize risks associated with conventional implantation methods.<br>
Materials and methods All procedures were performed using a new device (P-U CelSite Port™ MS; Toray Medical, Tokyo, Japan) under ultrasound guidance. The primary endpoint was the implantation success rate. The secondary endpoints were the safety and risk factors for infection in the early postprocedural period (< 30 days).<br>
Results We assessed 523 CV-port implantations performed in a cumulative total of 523 patients (240 men and 283 women; mean age, 61.6 } 13.1 years; range, 18–85 years). All implantations were successfully performed using an inner guide tube and over-the-wire technique through 522 internal jugular veins and one subclavian vein. The mean procedural time was 33.2 } 10.9 min (range 15–112 min). Air embolism, rupture/perforation of the superior vena cava, or hemothorax did not occur during catheter insertion. Eleven (2.1%) intraprocedural complications occurred, including Grade I arrhythmia (n = 8) and subcutaneous bleeding (n = 1), Grade II arrhythmia (n = 1), and Grade IIIa pneumothorax (n = 1). Furthermore, 496 patients were followed up for ≥ 30 days. Six early postprocedural complications were encountered (1.1%), including Grade IIIa infection (n = 4), catheter occlusion (n = 1), and skin necrosis due to subcutaneous leakage of trabectedin (n = 1). These six CV-ports were withdrawn, and no significant risk factors for infection in the early postprocedural period were identified.<br>
Conclusion The implantation of this CV-port device demonstrated comparable success and complication rates to conventional devices, with the added potential benefit of eliminating complications associated with the use of a peel-away sheath.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1341-96253082025Percutaneous cryoablation versus robot-assisted partial nephrectomy for small renal cell carcinoma: a retrospective cost analysis at Japanese single-institution16211630ENMayuUkaDepartment of Radiology, Okayama University HospitalToshihiroIguchiDepartment of Radiology, Okayama University HospitalKensukeBekkuDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTomoakiYamanoiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesToshiharuMitsuhashiCenter for Innovative Clinical Medicine, Okayama University HospitalHideoGobaraDivision of Medical Informatics, Okayama University HospitalNoriyukiUmakoshiDepartment of Radiology, Okayama University HospitalTakahiroKawabataDepartment of Radiology, Okayama University HospitalKojiTomitaDepartment of Radiology, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityBackground: No direct cost comparison has been conducted between percutaneous cryoablation (PCA) and robot-assisted partial nephrectomy (RAPN) for clinical T1a renal cell carcinoma (RCC) in Japan. This study aimed to compare their costs.<br>
Methods: We retrospectively analyzed data from 212 PCAs (including 155 with transcatheter arterial embolization) and 119 RAPN cases performed between December 2017 and May 2022.<br>
Results: PCA patients were older with higher American Society of Anesthesiologists scores, Charlson Comorbidity Index, and history of previous RCC treatment, cardiovascular disease, and antithrombotic drug use than RAPN patients. PCA was associated with a significantly shorter procedure time and hospitalization duration with fewer major complications than those associated with RAPN. While PCA incurred a slightly lower total cost (1,123,000 vs. 1,155,000 yen), it had a significantly higher procedural cost (739,000 vs. 693,000 yen) and markedly worse total (| 93,000 vs. 249,000 yen) and procedural income-expenditure balance (| 189,000 vs. 231,000 yen) than those of RAPN. After statistical adjustment, PCA demonstrated significantly higher total (difference: 114,000 yen) and procedural costs (difference: 72,000 yen), alongside significantly worse total (difference: | 358,000 yen) and procedural income-expenditure balances (difference: | 439,000 yen). The incremental cost-effectiveness ratio was more favorable for PCA than for RAPN.<br>
Conclusion: For high- risk patients, PCA demonstrated a safer option with shorter hospitalization duration than those of RAPN. Although PCA was more cost-effective, its higher procedural cost and unfavorable income-expenditure balance require careful evaluation, especially for large tumors that require three or more needles.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7922025Potential for Radiation Dose Reduction in Temporal Bone CT Imaging Using Photon-Counting Detector CT7580ENFumiyoHigakiDepartment of Radiology, Okayama University HospitalYusukeMorimitsuDepartment of Radiological Technology, Okayama University HospitalToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversitySung IlHwangDepartment of Radiology, Seoul National University Bundang HospitalTakahiroKitayamaDepartment of Radiology, Okayama University HospitalYukaTakahashiDepartment of Radiology, Okayama University HospitalMayuUkaDepartment of Radiology, Okayama University HospitalNoriakiAkagiDepartment of Radiological Technology, Okayama University HospitalAkikoSugayaDepartment of Otolaryngology-Head and Neck Surgery, Okayama University HospitalToshiharuMitsuhashiCenter for Innovative Clinical Medicine, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesTakaoHirakiDepartment of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article10.18926/AMO/68645Temporal bone computed tomography (CT) is frequently performed for pediatric patients with ear diseases. Advances in CT technology have improved diagnostic imaging quality, but reduction of radiation exposure remains a goal. We evaluated the potential for radiation dose reduction in temporal bone CT examinations using porcine ear ossicles and a photon-counting detector CT system. Three scans of the bilateral temporal bone were performed on each of three pig cadaver heads. In each of seven successive imaging sessions, the radiation dose was reduced by an additional one-seventh of the recommended dose (RD). Two board-certified radiologists independently scored the resulting images on a scale of 1 to 5 points, where 5 represented the image quality at the RD. Images scoring ≥4.5 points were considered acceptable. Noise was assessed in a 2-cm-diameter region near the ear ossicles, and standard deviation was measured for each of the seven decrements from the RD. As the radiation dose decreased, the noise progressively increased, and visual assessment scores progressively decreased. Acceptable image scores were obtained at six-sevenths (4.9), five-sevenths (4.8), four-sevenths (4.7), and three-sevenths (4.6) of the RD. Thus, acceptable porcine temporal bone CT images were obtained with a radiation dose reduction of approximately 50%.No potential conflict of interest relevant to this article was reported. Medknow PublicationsActa Medica Okayama0971-62035012025Investigating the Effects of Reconstruction Conditions on Image Quality and Radiomic Analysis in Photon-counting Computed Tomography100107ENMiyuOhataDepartment of Radiological Technology, Graduate School of Health Sciences, Okayama UniversityRyoheiFukuiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityYusukeMorimitsuDivision of Radiological Technology, Okayama University HospitalDaichiKobayashiDivision of Radiological Technology, Okayama University HospitalTakatsuguYamauchiDivision of Radiological Technology, Okayama University HospitalNoriakiAkagiDivision of Radiological Technology, Okayama University HospitalMitsugiHondaDivision of Radiological Technology, Okayama University HospitalAikoHayashiDepartment of Radiology, Hiroshima University HospitalKoshiHasegawaDepartment of Radiological Technology, Graduate School of Health Sciences, Okayama UniversityKatsuhiroKidaDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversitySachikoGotoDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical, Okayama UniversityIntroduction:Photon-counting computed tomography (CT) is equipped with an adaptive iterative reconstruction method called quantum iterative reconstruction (QIR), which allows the intensity to be changed during image reconstruction. It is known that the reconstruction conditions of CT images affect the analysis results when performing radiomic analysis. The aim of this study is to investigate the effect of QIR intensity on image quality and radiomic analysis of renal cell carcinoma (RCC).<br>
Materials and Methods:The QIR intensities were selected as off, 2 and 4. The image quality evaluation items considered were task-based transfer function (TTF), noise power spectrum (NPS), and low-contrast object specific contrast-to-noise ratio (CNRLO). The influence on radiomic analysis was assessed using the discrimination accuracy of clear cell RCC.<br>
Results:For image quality evaluation, TTF and NPS values were lower and CNRLO values were higher with increasing QIR intensity; for radiomic analysis, sensitivity, specificity, and accuracy were higher with increasing QIR intensity. Principal component analysis and receiver operating characteristics analysis also showed higher values with increasing QIR intensity.<br>
Conclusion:It was confirmed that the intensity of the QIR intensity affects both the image quality and the radiomic analysis.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7912025Prediction of Prostate Cancer Grades Using Radiomic Features2130ENYasuhiroYamamotoDepartment of Radiology, Houshasen Daiichi HospitalTakafumiHaraguchiDepartment of Advanced Biomedical Imaging and Informatics, St. Marianna University School of MedicineKaoriMatsudaDepartment of Radiology, Houshasen Daiichi HospitalYoshioOkazakiDepartment of Radiology, Houshasen Daiichi HospitalShinKimotoDepartment of Radiology, Houshasen Daiichi HospitalNozomuTanjiDepartment of Urology, Houshasen Daiichi HospitalAtsushiMatsumotoDepartment of Urology, Houshasen Daiichi HospitalYasuyukiKobayashiDepartment of Medical Information and Communication Technology Research, St. Marianna University School of MedicineHidefumiMimuraDepartment of Radiology, St. Marianna University School of MedicineTakaoHirakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article10.18926/AMO/68355We developed a machine learning model for predicting prostate cancer (PCa) grades using radiomic features of magnetic resonance imaging. 112 patients diagnosed with PCa based on prostate biopsy between January 2014 and December 2021 were evaluated. Logistic regression was used to construct two prediction models, one using radiomic features and prostate-specific antigen (PSA) values (Radiomics model) and the other Prostate Imaging-Reporting and Data System (PI-RADS) scores and PSA values (PI-RADS model), to differentiate high-grade (Gleason score [GS] ≥ 8) from intermediate or low-grade (GS < 8) PCa. Five imaging features were selected for the Radiomics model using the Gini coefficient. Model performance was evaluated using AUC, sensitivity, and specificity. The models were compared by leave-one-out cross-validation with Ridge regularization. Furthermore, the Radiomics model was evaluated using the holdout method and represented by a nomogram. The AUC of the Radiomics and PI-RADS models differed significantly (0.799, 95% CI: 0.712-0.869; and 0.710, 95% CI: 0.617-0.792, respectively). Using holdout method, the Radiomics model yielded AUC of 0.778 (95% CI: 0.552-0.925), sensitivity of 0.769, and specificity of 0.778. It outperformed the PI-RADS model and could be useful in predicting PCa grades, potentially aiding in determining appropriate treatment approaches in PCa patients.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1612-90592032023Outcomes of solitary postoperative recurrence of esophageal squamous cell carcinoma diagnosed with FDG-PET/CT and treated with definitive radiation therapy548556ENHirokiIharaDepartment of Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKotaroYoshioDepartment of Proton Beam Therapy, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityShunsukeTanabeDepartment of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversitySoichiSugiyamaDepartment of Proton Beam Therapy, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityMasashiHashimotoDepartment of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityNaoakiMaedaDepartment of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityShinsukeAkagiDepartment of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversitySoshiTakaoDepartment of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKazuhiroNomaDepartment of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityBackground Surgical resection of esophageal cancer is frequently performed to achieve a complete cure. However, the postoperative recurrence rate is 36.8–42.5%, leading to poor prognosis. Radiation therapy has been used to treat recurrences; solitary recurrence has been proposed as a prognostic factor for radiation therapy, though its significance is unclear. 18F-fluorodeoxyglucose positron emission tomography is a highly accurate diagnostic modality for esophageal cancer. This retrospective study aimed to analyze the outcomes of solitary postoperative recurrences of esophageal squamous cell carcinoma diagnosed with 18F-fluorodeoxyglucose positron emission tomography and treated with definitive radiation therapy.<br>
Methods We examined 27 patients who underwent definitive radiation therapy for single or multiple postoperative recurrences of esophageal squamous cell carcinoma between May 2015 and April 2021. 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed within 3 months before the commencement of radiation therapy. Kaplan–Meier, univariate, and multivariate analyses were performed to examine the overall survival and identify potential prognostic factors.<br>
Results The 1-, 2-, and 3-year overall survival rates were 85.2%, 62.6%, and 47.3%, respectively, and solitary recurrence was the only significant factor associated with overall survival (P = 0.003). The 1-, 2-, and 3-year overall survival rates in patients with solitary recurrence were 91.7%, 80.2%, and 80.2%, respectively, and in patients with multiple recurrences they were 80.0%, 50.3%, and 25.1%, respectively. Multivariate analysis also showed solitary recurrence as a significant factor for overall survival.<br>
Conclusions When diagnosed with 18F-fluorodeoxyglucose positron emission tomography/computed tomography, solitary recurrence appears to have a more favorable prognosis than multiple recurrences.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1867-10714242023Time course of complications after small renal mass biopsy: evaluation of initial follow-up images398405ENSoichiroKajitaDepartment of Radiology, Okayama University HospitalToshihiroIguchiDepartment of Radiology, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKojiTomitaDepartment of Radiology, Okayama University HospitalMayuUkaDepartment of Radiology, Okayama University HospitalNoriyukiUmakoshiDepartment of Radiology, Okayama University HospitalTakahiroKawabataDepartment of Radiology, Okayama University HospitalKazuakiMunetomoDepartment of Radiology, Okayama University HospitalTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityPurpose To retrospectively assess the time course of complications after image-guided small renal mass biopsy using initial follow-up imaging.<br>
Materials and methods A total of 190 masses (mean, 2.1 } 0.70 cm; range, 0.6–3.8 cm) were assessed using initial computed tomography (43 non-enhanced and 141 enhanced) or magnetic resonance imaging (five non-enhanced and one enhanced) after biopsy. Initial follow-up imaging was classified into two groups (i.e., with or without hematoma) and various factors were compared.<br>
Results The masses were histologically diagnosed in all patients except one. Post-procedural complications included 129 Grade I hematomas, 1 Grade I hemothorax, 9 Grade II hematomas, and 1 Grade IIIa pneumothorax. Residual 28 Grade I and 6 Grade II hematomas and 8 new complications (6 small hematomas, 1 pseudoaneurysm, and 1 arteriovenous fistula) were observed on the initial follow-up imaging obtained at a median of 21 days (3–90 days) after the biopsy. On the initial follow-up imaging, the groups with and without hematoma differed significantly in the following factors: age (P = 0.04), size (P = 0.02), guided images (P < 0.01), hematoma at the end of the procedure (P < 0.01), and days after biopsy (P < 0.01). Although three masses exhibited > 25% shrinkage, no significant change was observed in mass diameter on initial follow-up imaging (mean, 2.1 } 0.71 cm; P = 0.90).<br>
Conclusion Initial follow-up imaging after a biopsy revealed improvements in most of the complications, a few new complications, and an unchanged mass diameter.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1867-10714232023Prospective evaluation of core number of biopsy for renal tumor: are multiple cores preferable?319325ENToshihiroIguchiDepartment of Radiology, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTomohiroTojiDepartment of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesJunSakuraiCenter for Innovative Clinical Medicine, Okayama University HospitalKojiTomitaDepartment of Radiology, Okayama University HospitalMayuUkaDepartment of Radiology, Okayama University HospitalNoriyukiUmakoshiDepartment of Radiology, Okayama University HospitalTakahiroKawabataDepartment of Radiology, Okayama University HospitalKazuakiMunetomoDepartment of Radiology, Okayama University HospitalToshiharuMitsuhashiCenter for Innovative Clinical Medicine, Okayama University HospitalTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityPurpose This single-center, single-arm, prospective, open-label study was conducted to evaluate the optimal number of cores (single or multiple) in renal tumor biopsy.<br>
Materials and methods Forty-four biopsies of 44 tumors (mean diameter, 2.7 } 1.0 cm; range, 1.6–5.0 cm) were included. Biopsy was performed under ultrasound or computed tomography fluoroscopy guidance using an 18-gauge cutting needle and the co-axial method. Two or more specimens were obtained, which were divided into first and subsequent specimens. gFirst specimenh and gall specimensh were histologically evaluated (i.e., appropriateness of specimen, histological diagnosis, subtype, and Fuhrman grade of renal cell carcinoma [RCC]) blindly and independently by two board-certified pathologists.<br>
Results Multiple specimens were successfully and safely obtained in all the biopsies. All tumors were histologically diagnosed; 40 malignancies included 39 RCCs and 1 solitary fibrous tumor, and 4 benign lesions included 2 angiomyolipomas, 1 oncocytoma, and 1 capillary hemangioma. In all RCCs, the subtype could be determined (32 clear cell RCCs, 4 chromophobe RCCs, and 3 papillary RCCs), and the Furman grade was determined in 38 RCCs. When only the first specimen was evaluated, 22.7% of the specimens were inappropriate for diagnosis, and 34 (77.3%) were histologically diagnosed. The diagnostic yield was significantly lower than that of all specimens (P = 0.0044). Univariate analysis revealed that smaller lesions were a significant predictor of diagnostic failure (P = 0.020).<br>
Conclusion Biopsy with multiple cores significantly improved diagnostic yield. Thus, operators should obtain multiple cores during renal tumor biopsy.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7822024Photon-Counting Detector CT: Potential for 75% Reduction in Contrast Medium Amount: A Phantom Study135142ENFumiyoHigakiDepartment of Radiology, Okayama University HospitalYusukeMorimitsuDepartment of Radiological Technology, Okayama University HospitalToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityHayatoSaitoDepartment of Radiological Technology, Okayama University Medical SchoolHaruhikoTakakiDepartment of Radiological Technology, Okayama University Medical SchoolAyakoNakagoshiDepartment of Radiological Technology, Okayama University Medical SchoolMakiWadaDepartment of Radiological Technology, Okayama University Medical SchoolMayuUkaDepartment of Radiology, Okayama University HospitalNoriakiAkagiDepartment of Radiological Technology, Okayama University HospitalToshiharuMitsuhashiCenter for Innovative Clinical Medicine, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesTakaoHirakiDepartment of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article10.18926/AMO/66916This study aimed to evaluate the potential reduction in contrast medium utilization using photon-counting detector computed tomography (PCD-CT). One PCD-CT scan (CT1) and three conventional (non-PCD-CT) CT scans (CT2-CT4) were performed using a multi-energy CT phantom that contained eight rods with different iodine concentrations (0.2, 0.5, 1, 2, 5, 10, 15, and 20 mg/ml). The CT values of the seven groups (CT1 for 40, 50, 60, and 70 keV; and CT2-4) were measured. Noise and contrast-to-noise ratio (CNR) were assessed for the eight rods at various iodine concentrations. CT2 and CT1 (40 keV) respectively required 20 mg/ml and 5 mg/ml of iodine, indicating that a comparable contrast effect could be obtained with approximately one-fourth of the contrast medium amount. The standard deviation values increased at lower energy levels irrespective of the iodine concentration. The CNR exhibited a decreasing trend with lower iodine concentrations, while it remained relatively stable across all iodine levels (40-70 keV). This study demonstrated that virtual monochromatic 40 keV images offer a similar contrast effect with a reduced contrast medium amount when compared to conventional CT systems at 120 kV.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1867-10714222023Evaluation of the ear ossicles with photon-counting detector CT158164ENYukaTakahashiDepartment of Radiology, Okayama University HospitalFumiyoHigakiDepartment of Radiology, Okayama University HospitalAkikoSugayaDepartment of Otolaryngology‑Head and Neck Surgery, Okayama University HospitalYudaiAsanoDepartment of Radiology, Okayama University HospitalKatsuhideKojimaDepartment of Radiology, Okayama University HospitalYusukeMorimitsuDepartment of Radiological Technology, Okayama University HospitalNoriakiAkagiDepartment of Radiological Technology, Okayama University HospitalToshihideItohDepartment of CT‑Research and Collaboration, Siemens HealthineersYusukeMatsuiDepartment of Radiology, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical SciencesTakaoHirakiDepartment of Radiology, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical SciencesRecently, computed tomography with photon-counting detector (PCD-CT) has been developed to enable high-resolution imaging at a lower radiation dose. PCD-CT employs a photon-counting detector that can measure the number of incident X-ray photons and their energy. The newly released PCD-CT (NAEOTOM Alpha, Siemens Healthineers, Forchheim, Germany) has been in clinical use at our institution since December 2022. The PCD-CT offers several advantages over current state-of-the-art energy-integrating detector CT (EID-CT). The PCD-CT does not require septa to create a detector channel, while EID-CT does. Therefore, downsizing the anode to achieve higher resolution does not affect the dose efficiency of the PCD-CT. CT is an indispensable modality for evaluating ear ossicles. The ear ossicles and joints are clearly depicted by PCD-CT. In particular, the anterior and posterior legs of the stapes, which are sometimes unclear on conventional CT scans, can be clearly visualized. We present cases of congenital anomalies of the ossicular chain, ossicular chain dislocation, tympanosclerosis, and cholesteatoma in which PCD-CT was useful. This short article reports the usefulness of PCD-CT in the 3D visualization of the ear ossicles.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7812024Regression of Necrotic Lesions after Methotrexate Withdrawal in Patients with Methotrexate-Associated Lymphoproliferative Disorders: A Retrospective CT Study2936ENTakahiroKitayamaDepartment of Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakashiTanakaDepartment of Radiology, Okayama City HospitalYuichiroKanieDepartment of Radiology, Okayama University HospitalYoheiMarukawaDepartment of Radiology, Okayama Saiseikai General HospitalKatsuhideKojimaDepartment of Radiology, Okayama University HospitalTakehiroTanakaDepartment of Pathology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversitySoshiTakaoDepartment of Epidemiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityOriginal Article10.18926/AMO/66668This retrospective study investigated whether necrotic lesions detected on a computed tomography (CT) scan are more regressive than non-necrotic lesions after methotrexate withdrawal in patients pathologically diagnosed with methotrexate-associated lymphoproliferative disorders (MTX-LPD). In total, 89 lesions extracted from 24 patients on CT scans were included in the analysis. All patients had been evaluated for the presence of necrosis within lesions via CT scan upon first suspicion of MTX-LPD (baseline CT scan). The percentage lesion size reduction between the baseline and initial follow-up CT scan was calculated. The association between necrosis within lesions and size changes was estimated via linear regression analyses using both crude and adjusted models. Necrosis was significantly more common in extranodal lesions (27 out of 30 lesions, 90%) than in nodal lesions (9 out of 59 lesions, 15%, p<0.001). In the crude model, the regression of necrotic lesions was 58.5% greater than that of non-necrotic lesions; the difference was statistically significant (p<0.001). Additionally, the longest diameter of necrotic lesions at the baseline CT scan was significantly greater than that of non-necrotic lesions (p<0.001). Based on the adjusted model, necrotic lesions showed 49.3% greater regression than non-necrotic lesions (p=0.017). Necrosis detected on a CT scan was found to be an independent predictor of regression after MTX withdrawal in patients with MTX-LPD.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7762023Omental Abscess after Laparoscopic Proximal Gastrectomy Successfully Treated with Percutaneous Drainage665669ENAtsunobuSakuraiDepartment of Radiology, Okayama University HospitalMayuUkaDepartment of Radiology, Okayama University HospitalToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityKojiTomitaDepartment of Radiology, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYoshihikoKakiuchiDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceShinjiKurodaDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceToshiyoshiFujiwaraDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityCase Report10.18926/AMO/66160We report the case details of a 65-year-old Japanese man with an omental abscess that was discovered 43 days after he underwent a laparoscopic proximal gastrectomy for gastric cancer. His chief complaint was mild abdominal pain that had persisted for several days. The abscess was diagnosed as a rare postoperative complication. We hesitated to perform a reoperation given the invasiveness of general anesthesia and surgery, plus the possibility of postoperative adhesions and because the patientfs general condition was stable and he had only mild abdominal pain. Percutaneous drainage using a 10.2-F catheter was performed with the patient under conscious sedation and computed tomography–fluoroscopy guidance, with no complications. After the procedure, the size of the abscess cavity was remarkably reduced, and 23 days later the catheter was withdrawn.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7762023A Case of Migration of a Hydrogel Spacer for Radiotherapy into the Pulmonary Artery647650ENKatsuhideKojimaDepartment of Radiology, Okayama University HospitalYukaTakahashiDepartment of Radiology, Okayama University HospitalSoichiSugiyamaDepartment of Proton Beam Therapy, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYudaiAsanoDepartment of Radiology, Okayama University HospitalNanakoOkawaDepartment of Radiology, Okayama University HospitalSatokoMakimotoDepartment of Radiology, Okayama University HospitalFumiyoHigakiDepartment of Radiology, Okayama University HospitalToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityCase Report10.18926/AMO/66157A 67-year-old man was referred to our hospital for the diagnosis and treatment of prostate cancer. Multidisciplinary discussion led to intensity-modulated radiotherapy preceded by hormone therapy. Before radiotherapy, a biodegradable hydrogel spacer (HS) was placed between the prostate and rectum to reduce radiation injury risk. Three weeks postplacement, pelvic magnetic resonance imaging revealed HS migration into the pelvic vein. Subsequent whole-body contrast-enhanced computed tomography (CECT) revealed HS migration into the pulmonary artery. The patient showed no symptoms or clinical signs. Radiotherapy was completed uneventfully. Complete absorption of the migrated HS was confirmed using CECT images 5 months postplacement.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1867-107140112022Percutaneous cryoablation for clinical T3a renal cell carcinoma (< 7 cm) with segmental vein involvement or perinephric fat invasion based on preoperative evaluation of high-resolution multidetector computed tomography scan12011209ENMayuUkaDepartment of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of MedicineToshihiroIguchiDepartment of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of MedicineNanakoOkawaDepartment of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of MedicineYusukeMatsuiDepartment of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of MedicineKojiTomitaDepartment of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of MedicineNoriyukiUmakoshiDepartment of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of MedicineKazuakiMunetomoDepartment of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of MedicineHideoGobaraDivision of Medical Informatics, Okayama University HospitalMotooArakiDepartment of Urology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of MedicineTakaoHirakiDepartment of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of MedicinePurpose@To retrospectively assess the feasibility, safety, renal function, technique efficacy rate, and survival of patients with clinical T3a renal cell carcinoma (RCC).<br>
Materials and methods@Sixteen cryoablation sessions were performed in 14 patients (10 men; mean age, 69.8 } 10.5 years; range, 49–90 years) with 14 clear cell T3a RCCs (mean, 3.3 } 0.9 cm; range, 1.9–5.2 cm). One patient was on dialysis. Transcatheter arterial embolization was performed before cryoablation in 15 sessions. The primary endpoint was the technique efficacy rate. The secondary endpoints included feasibility, safety, renal function, and survival.<br>
Results@Cryoablation was technically successful in all RCC cases. In two RCCs, cryoablation was performed twice because of local tumor progression. No major adverse events were observed. All patients were alive without metastases, with a median follow-up of 45 months (6|93 months). Complete response was achieved by cryoablation in 11 RCCs (78.6%). The primary and secondary technique efficacy rates were 77.1% and 84.4% at 1 year, 57.9% and 73.9% at 3 years, and 57.9% and 73.9% at 5 years, respectively. One patient underwent dialysis given a total contralateral nephrectomy due to another RCC 1 month after initial cryoablation and a total ipsilateral nephrectomy 46 months after initial cryoablation due to local progression. Except for two dialysis patients, of the 12 patients with a median follow-up of 41 months (6–93 months), none were on dialysis.<br>
Conclusion@Cryoablation was safe and effective in T3a RCC, which mainly involved the renal venous branches and may represent an alternative treatment for inoperable patients.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1867-107140102022Evidence on percutaneous radiofrequency and microwave ablation for liver metastases over the last decade10351045ENKojiTomitaDepartment of Radiology, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityMayuUkaDepartment of Radiology, Okayama University HospitalNoriyukiUmakoshiDepartment of Radiology, Okayama University HospitalTakahiroKawabataDepartment of Radiology, Okayama University HospitalKazuakiMunetomoDepartment of Radiology, Okayama University HospitalShomaNagataDepartment of Radiology, Okayama University HospitalToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityPurpose@This review aimed to summarize the treatment outcomes of percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) for metastatic liver tumors based on the findings of published studies over the last decade.<br>
Materials and methods@Literature describing the survival outcomes of ablation therapy for liver metastases was explored using the PubMed database on April 26, 2022, and articles published in 2012 or later were selected. The included studies met the following criteria: (i) English literature, (ii) original clinical studies, and (iii) literature describing overall survival (OS) of thermal ablation for metastatic liver tumors. All case reports and cohort studies with fewer than 20 patients and those that evaluated ablation for palliative purposes were excluded.<br>
Results@RFA was the most commonly used method for ablation, while MWA was used in several recent studies. RFA and MWA for liver metastases from various primary tumors have been reported; however, majority of the studies focused on colorectal cancer. The local control rate by RFA and MWA varied widely among the studies, ranging approximately 50–90%. Five-year survival rates of 20–60% have been reported following ablation for colorectal liver metastases by a number of studies, and several reports of 10-year survival rates were also noted.<br>
Conclusion@Comparative studies of local therapies for colorectal liver metastases demonstrated that RFA provides comparable survival outcomes to surgical metastasectomy and stereotactic body radiation therapy.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1867-107140102022Up-to-date evidence on image-guided thermal ablation for metastatic lung tumors: a review10241034ENYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKojiTomitaDepartment of Radiology, Okayama University HospitalMayuUkaDepartment of Radiology, Okayama University HospitalNoriyukiUmakoshiDepartment of Radiology, Okayama University HospitalTakahiroKawabataDepartment of Radiology, Okayama University HospitalKazuakiMunetomoDepartment of Radiology, Okayama University HospitalShomaNagataDepartment of Radiology, Okayama University HospitalToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityThe aim of this review was to summarize the latest evidence on image-guided thermal ablation therapies for lung metastases. PubMed was used to search for relevant articles that reported the oncological outcomes of thermal ablation for metastatic lung tumors, and those published in 2010 or later were selected for review. Ablative therapies were applied for lung metastases from various types of primary tumors, but most commonly colorectal ones. Radiofrequency ablation (RFA) was the most evaluated technique, followed by microwave ablation (MWA). The local control rates of ablative therapies were generally favorable, approximately 80–90% in many studies. Representative studies demonstrated promising overall survival rates of approximately 50% or higher 5 years after ablation for lung metastases from colorectal cancer or mixed types of primary tumors. Nevertheless, the survival outcomes varied depending on the type of primary tumor and background factors of patients such as other metastases and comorbidities. Several studies had aimed to compare the outcomes of various ablative therapies such as RFA, MWA, and cryoablation; however, conclusive data are not yet available to determine the most appropriate ablation modality for lung metastases. Further data accumulation is needed, especially for long-term outcomes and comparisons with other therapies.No potential conflict of interest relevant to this article was reported.MDPIActa Medica Okayama2072-669415142023Image-Guided Ablation Therapies for Extrahepatic Metastases from Hepatocellular Carcinoma: A Review3665ENNoriyukiUmakoshiDepartment of Radiology, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKojiTomitaDepartment of Radiology, Okayama University HospitalMayuUkaDepartment of Radiology, Okayama University HospitalTakahiroKawabataDepartment of Radiology, Okayama University HospitalToshihiroIguchiDepartment of Radiological Technology, Okayama University Graduate School of Health ScienceTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversitySimple Summary Although systemic therapies are a common treatment for patients with extrahepatic metastases from hepatocellular carcinoma (HCC), local ablative therapies, such as radiofrequency ablation, microwave ablation, and cryoablation, can be used in select patients who have metastases to the lung, bone, and other sites with curative or palliative intent. This review summarizes the currently available evidence on image-guided thermal ablation therapies for extrahepatic metastases from HCC. The most common sites of extrahepatic metastases from hepatocellular carcinoma (HCC) are the lungs, intra-abdominal lymph nodes, bones, and adrenal glands, in that order. Although systemic therapies are a common treatment for patients with extrahepatic metastases, local ablative therapies for the extrahepatic metastatic lesions can be performed in selected patients. In this article, the literature on image-guided thermal ablation for metastasis to each organ was reviewed to summarize the current evidence. Radiofrequency ablation was the most commonly evaluated technique, and microwave ablation, cryoablation, and percutaneous ethanol injection were also utilized. The local control rate of thermal ablation therapy was relatively favorable, at approximately 70-90% in various organs. The survival outcomes varied among the studies, and several studies reported that the absence of viable intrahepatic lesions was associated with improved survival rates. Since only retrospective data from relatively small studies has been available thus far, more robust studies with prospective designs and larger cohorts are desired to prove the usefulness of thermal ablation for extrahepatic metastases from HCC.No potential conflict of interest relevant to this article was reported.‰ªŽRˆãŠw‰ïActa Medica Okayama0030-155813432022”xŠà‚ɑ΂·‚é”ñŒŒŠÇŒnIVR145151ENTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityNo potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1867-10712023Renal cryoablation combined with prior transcatheter arterial embolization in non-dialysis patients with stage 4 or 5 chronic kidney disease: a retrospective studyENNoriyukiUmakoshiDepartment of Radiology, Okayama University HospitalToshihiroIguchiDeptartment of Radiological Technology, Okayama University Graduate School of Health ScienceYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKojiTomitaDepartment of Radiology, Okayama University HospitalMayuUkaDepartment of Radiology, Okayama University HospitalTakahiroKawabataDepartment of Radiology, Okayama University HospitalKazuakiMunetomoDepartment of Radiology, Okayama University HospitalShomaNagataDepartment of Radiology, Okayama University HospitalHideoGobaraDivision of Medical Informatics, Okayama University HospitalMotooArakiDepartment of Urology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityPurpose@To retrospectively evaluate cryoablation combined with prior transcatheter arterial embolization (TAE) for renal cell carcinoma (RCC) in non-dialysis patients with stage 4 or 5 chronic kidney disease (CKD).<br>
Materials and methods@Patients with stage 4 or 5 CKD undergoing TAE and cryoablation for RCC between May 2012 and October 2021 were included. TAE was selectively performed using iodized oil with absolute ethanol or gelatin sponge 1–14 days before cryoablation. Local efficacy, safety, and changes in renal function were evaluated.<br>
Results@Nine patients (seven men and two women; median age, 64 years; range 52–88 years) with nine RCCs (mean diameter, 3.0 } 1.0 cm; range 1.7–4.7 cm) were included. The mean pre-treatment estimated glomerular filtration rate (eGFR) was 24.2 } 5.6 ml/min/1.73 m2 (range 10.4–29.2 ml/min/1.73 m2). The mean amount of contrast medium used in TAE was 58 } 29 ml (range 40–128 ml). Except in one patient (grade 3 pyelonephritis), no grade ≥ 3 complications occurred. During the follow-up period (median, 18 months; range 7–54 months), no local tumor progression occurred. In two patients with pre-treatment eGFR of < 20 ml/min/1.73 m2, hemodialysis was initiated at 3 and 19 months after cryoablation. At their last follow-up, the remaining seven patients showed a decrease of 6.2 } 5.3 ml/min/1.73 m2 (range 0.7–17.2 ml/min/1.73 m2) in their eGFR.<br>
Conclusion@Cryoablation combined with TAE for RCC in non-dialysis patients with stage 4 or 5 CKD was effective and safe, with an acceptable impact on renal function.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7712023Navicular Bone Fracture after Radiofrequency Ablation in a Patient with Osteoid Osteoma8184ENKojiTomitaDepartment of Radiology, Okayama University HospitalToshihiroIguchiDepartment of Radiology, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesMayuUkaDepartment of Radiology, Okayama University HospitalEijiNakataDepartment of Orthopaedic Surgery, Okayama University HospitalTakaoHirakiDepartment of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesCase Report10.18926/AMO/64366Osteoid osteoma (OO) is a benign bone tumor that presents with nocturnal pain. Computed tomography (CT)- guided radiofrequency ablation (RFA) has been widely performed for OO, and major adverse events post-RFA are rare. We report a case of OO in the left navicular bone of a 15-year-old male. He underwent RFA for OO, and the pain improved temporarily. At the 1-month follow-up, the patient complained of left foot pain, and a CT examination revealed a fracture of the ablated navicular bone. Fractures are rare but must be taken into account after bone RFA.No potential conflict of interest relevant to this article was reported.Oxford University Press on behalf of The Japanese Radiation Research Society and Japanese Society for Radiation OncologyActa Medica Okayama0449-30602022Tumor size before image-guided brachytherapy is an important factor of local control after radiotherapy for cervical squamous cell carcinoma: analysis in cases using central shieldingENKotaroYoshioDepartment of Proton Beam Therapy, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityHirokiIharaDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKazuhiroOkamotoDepartment of Obstetrics and Gynecology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityEtsujiSuzukiDepartment of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakeshiOgataDepartment of Radiology, Tsuyama Central HospitalSoichiSugiyamaDepartment of Proton Beam Therapy, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKeiichiroNakamuraDepartment of Obstetrics and Gynecology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityShojiNagaoDepartment of Obstetrics and Gynecology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityHisashiMasuyamaDepartment of Obstetrics and Gynecology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityWe analyzed the local control (LC) of cervical squamous cell carcinoma treated by computed tomography (CT)-based image-guided brachytherapy (IGBT) using central shielding (CS). We also examined the value of tumor diameter before brachytherapy (BT) as a factor of LC. In total, 97 patients were analyzed between April 2016 and March 2020. Whole-pelvic (WP) radiotherapy (RT) with CS was performed, and the total pelvic sidewall dose was 50 or 50.4 Gy; IGBT was delivered in 3-4 fractions. The total dose was calculated as the biologically equivalent dose in 2 Gy fractions, and distribution was modified manually by graphical optimization. The median follow-up period was 31.8 months (6.3-63.2 months). The 1- and 2-year LC rates were 89% and 87%, respectively. The hazard ratio was 10.11 (95% confidence interval: 1.48-68.99) for local recurrence in those with a horizontal tumor diameter >= 4 cm compared to those with < 4 cm before BT. In CT-based IGBT for squamous cell carcinoma, favorable LC can be obtained in patients with a tumor diameter < 4 cm before BT. However, if the tumor diameter is >= 4 cm, different treatment strategies such as employing interstitial-BT for dose escalation may be necessary.No potential conflict of interest relevant to this article was reported.Hindawi Ltd.Acta Medica Okayama2090-652820222022Two Cases of Duodenal Ulcers That Developed after Transcatheter Procedures for Unruptured Visceral Artery Aneurysms9988216ENMasayaIwamuroDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesYusukeKawaiDepartment of Gastroenterology, Mitoyo General HospitalMayuUkaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesYusukeMatsuiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTakaoHirakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesYoshiroKawaharaDepartment of Practical Gastrointestinal Endoscopy, Okayama University HospitalHiroyukiOkadaDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesHerein, we report two cases of duodenal ulcers that developed after transcatheter procedures for the treatment of unruptured artery aneurysms. Both patients recovered after the administration of nothing by mouth, intravenous fluids, and proton-pump inhibitors. Notably, the duodenal ulcer was unchanged in one patient six days after endovascular treatment and improved in the other patient 13 days after angiography. These cases suggest that conservative treatment is acceptable in patients with duodenal ischemia that develops as an adverse effect of endovascular procedures. The usefulness of esophagogastroduodenoscopy in such patients has also been highlighted.No potential conflict of interest relevant to this article was reported.Sage Publications Ltd.Acta Medica Okayama2058-46011142022MRI multiparametric scoring system for pial blood supply of intracranial meningiomasENFumiyoHigakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSatoshiInoueDepartment of Neurosurgery, Okayama City HospitalWakakoOdaDepartment of Pathology, Okayama City HospitalEijiMatsusueDepartment of Radiology, Tottori Prefectural Central HospitalTakaoHirakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesBackground: Meningiomas are occasionally fed by pial blood supply (PBS). It is postulated that peritumoral flow void (PTFV), peritumoral brain edema (PTBE), and absence of an arachnoid plane (AP) are useful parameters for evaluating PBS. Purpose: To determine whether conventional magnetic resonance imaging (MRI) using a multiparametric scoring system (MSS) is a useful way to predict PBS. Material and Methods: Forty-six patients were included and divided: PBS and non-PBS groups. Differences between the groups in six parameters of MR imaging were analyzed: tumor size, tumor location, PTBE grade, AP grade, PTFV, and MIB1 labeling index (MIB1-LI) grade. Cutoff values were determined using receiver operating characteristic (ROC) curve analysis for the differentiation of both groups based on statistically significant parameters. All cases were scored as 1 (PBS) or 0 (non-PBS) for each parameter according to set thresholds. Individual scores were totaled for each case, yielding a combined score for each case to obtain a cutoff value using ROC curve analysis for the MSS. Results: Peritumoral brain edema grade, AP grade, PTFV, and MIB-LI grade were statistically associated with PBS. Receiver operating characteristic curve analyses showed that PTBE grade 3 or 4, AP grade 3 or 4, and PTFV positivity had the highest accuracy of 69%, 64%, and 68%, respectively. Regarding the MSS, a cutoff value of 2 had the highest accuracy of 71%; PBS diagnosis was indicated by at least two of the three parameters, namely, PTBE grade, AP grade, and PTFV. Conclusion: The MSS is a useful way to predict PBS in intracranial meningiomas on MRI.No potential conflict of interest relevant to this article was reported.Springer natureActa Medica Okayama2509-9280412021Bone microarchitectural analysis using ultra-high-resolution CT in tiger vertebra and human tibia4ENRyotaInaiDepartment of Radiology, Okayama University Medical SchoolRyuichiNakaharaIntelligent Orthopaedic System Development, Okayama University Medical SchoolYusukeMorimitsuDevision of Radiology, Medical Support Department, Okayama University HospitalNoriakiAkagiDevision of Radiology, Medical Support Department, Okayama University HospitalYouheiMarukawaDepartment of Radiology, Okayama University Medical SchoolToshiMatsushitaDevision of Radiology, Medical Support Department, Okayama University HospitalTakashiTanakaDepartment of Radiology, Okayama University Medical SchoolAkihiroTadaDepartment of Radiology, Okayama University Medical SchoolTakaoHirakiDepartment of Radiology, Okayama University Medical SchoolYoshihisaNasuMedical materials for musculoskeletal reconstruction, Okayama University Medical SchoolKeiichiroNishidaOrthopaedic Surgery, Okayama University Medical SchoolToshifumiOzakiOrthopaedic Surgery, Okayama University Medical SchoolSusumuKanazawaDepartment of Radiology, Okayama University Medical SchoolBackground 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.Nature ResearchActa Medica Okayama2045-23221112021Sarcopenia is associated with poor prognosis after chemoradiotherapy in patients with stage III non-small-cell lung cancer: a retrospective analysis11882ENKuniakiKatsuiDepartment of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakeshiOgataDepartment of Radiology, Iwakuni Clinical CenterSoichiSugiyamaDepartment of Radiology, Okayama University HospitalKotaroYoshioDepartment of Radiology, Okayama University HospitalMasahiroKurodaDepartment of Radiological Technology, Graduate School of Health Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKatsuyukiKiuraDepartment of Allergy and Respiratory Medicine, Okayama University HospitalYoshinobuMaedaDepartment of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesShinichiToyookaDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSusumuKanazawaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesWe 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 LLCActa Medica Okayama1867-1071392021Imaging evaluation of hereditary renal tumors: a pictorial review619632ENTakashiTanakaDepartment of Radiology, Okayama University HospitalAkiraKawashimaDepartment of Radiology, Mayo ClinicYoheiMarukawaDepartment of Radiology, Okayama University HospitalTakahiroKitayamaDepartment of Radiology, Okayama University HospitalYoshihisaMasaokaDepartment of Radiology, Okayama University HospitalKatsuhideKojimaDepartment of Radiology, Okayama University HospitalToshihiroIguchiDepartment of Radiology, Okayama University HospitalTakaoHirakiDepartment of Radiology, Okayama University HospitalSusumuKanazawaDepartment 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 radiologistfs perspective to facilitate the clinical decision-making process for patient management.No potential conflict of interest relevant to this article was reported.BMCActa Medica Okayama1748-717X1612021Lung stereotactic body radiation therapy for elderly patients aged >= 80 years with pathologically proven early-stage non-small cell lung cancer: a retrospective cohort study39ENKentaWatanabeDepartment of Radiology, Okayama University HospitalKuniakiKatsuiDepartment of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesSoichiroSugiyamaDepartment of Radiology, Okayama University HospitalKotaroYoshioDepartment of Radiology, Okayama University HospitalMasahiroKurodaDepartment of Radiological Technology, Graduate School of Health Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesKatsuyukiKiuraDepartment of Allergy and Respiratory Medicine, Okayama University HospitalYoshinobuMaedaDepartment of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry,and Pharmaceutical SciencesShinichiToyookaDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesSusumuKanazawaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesBackground</br>
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.</br>
Methods</br>
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.</br>
Results</br>
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.</br>
Conclusions</br>
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 SchoolActa Medica Okayama0386-300X7512021Volumetric PET Parameters Predict Prognosis after Definitive Chemoradiotherapy with Cisplatin/Docetaxel for Stage III Non-Small Cell Lung Cancer1523ENKuniakiKatsuiDepartment of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakeshiOgataDepartment of Radiology, Iwakuni Clinical CenterAkihiroTadaDepartment of Radiology, Okayama Diagnostic Imaging CenterSoichiSugiyamaDepartment of Radiology, Okayama University HospitalKotaroYoshioDepartment of Radiology, Okayama University HospitalMasahiroKurodaDepartment of Radiological Technology, Graduate School of Health Sciences, Okayama UniversityKatsuyukiKiuraAllergy and Respiratory Medicine, Okayama University HospitalYoshinobuMaedaHematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShinichiToyookaGeneral Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakaoHirakiRadiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSusumuKanazawaRadiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article10.18926/AMO/61429The 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 SchoolActa Medica Okayama0386-300X7512021Needle Tract Ablation in Liver Tissue Using a Cryoprobe Combined with an Electrosurgical Device: Influence of ex vivo and in vivo Animal Models914ENHideoGobaraDivision of Medical Informatics, Okayama University HospitalAkiraYamamotoDepartment of Diagnostic and Interventional Radiology, Osaka City University Graduate School of MedicineToshiyukiKomakicDepartment of Radiology, Okayama University HospitalToshiakiKitayamaDepartment of Radiology, Otemae HospitalJunSakuraiCenter for Innovative Clinical Medicine, Okayama University HospitalToshihiroIguchiDepartment of Radiology, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Okayama University HospitalMayuUkaDepartment of Radiology, Okayama University HospitalKojiTomitaDepartment of Radiology, Okayama University HospitalTakaoHirakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSusumuKanazawaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article10.18926/AMO/61428To 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 algorithmfs 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.Okayama University Medical SchoolActa Medica Okayama0386-300X7452020Combined Laparoscopic and CT Monitoring of the Ice-Ball Margin during Cryoablation for Renal Cell Carcinoma Associated with von Hippel-Lindau Disease: First Case443448ENTakanoriSekitoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakaoHirakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMayuUkaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToshiyukiKomakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYusukeMatsuiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToshihiroIguchiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSatoshiKatayamaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKasumiYoshinagaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShogoWatariDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYukiMaruyamaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYosukeMitsuiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesRisaKubotaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakuyaSadahiraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShingoNishimuraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoichiroWadaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesAtsushiTakamotoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoheiEdamuraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomokoSakoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToyohikoWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSusumuKanazawaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasutomoNasu Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesCase Report10.18926/AMO/60806We 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 CompanyActa Medica Okayama2218-676X982020Radiation therapy for oligometastatic bone disease in breast cancer50965101ENNorihisaKatayamaDepartment of Radiology, Okayama University Medical SchoolKuniakiKatsuiDepartment of Radiology, Okayama University Medical SchoolKentaWatanabeDepartment of Radiology, Okayama University Medical SchoolRyotaNagaoDepartment of Radiology, Okayama University Medical SchoolKahoOtsukiDepartment of Radiology, Okayama University Medical SchoolTakaoHirakiDepartment of Radiology, Okayama University Medical SchoolSusumuKanazawaDepartment of Radiology, Okayama University Medical SchoolBreast 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.Okayama University Medical SchoolActa Medica Okayama0386-300X7432020A Clinical Study Evaluating an Aspiration-type Semi-Automatic Cutting Biopsy Needle (SCIRO-1702)209214ENYusukeMatsuiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakaoHirakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToshihiroIguchiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesJunSakuraiCenter for Innovative Clinical MedicineMayuUkaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYoshihisaMasaokaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHideoGobaraDivision of Medical Informatics, Okayama University HospitalSusumuKanazawaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article10.18926/AMO/59951An 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.WileyActa Medica Okayama2045-76342020Radiation pneumonitis after definitive concurrent chemoradiotherapy with cisplatin/docetaxel for non-small cell lung cancer: Analysis of dose-volume parametersENKuniakiKatsuiDepartment of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceTakeshiOgataDepartment of Radiology, Iwakuni Clinical CenterKentaWatanabeDepartment of Radiology, Okayama University HospitalNorihisaKatayamaDepartment of Radiology, Okayama University HospitalMasahiroKurodaDepartment of Radiological Technology, Graduate School of Health Sciences, Okayama UniversityKatsuyukiKiuraDepartment of Allergy and Respiratory Medicine, Okayama University HospitalTakaoHirakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceYoshinobuMaedaDepartment of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceShinichiToyookaDepartments of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceSusumuKanazawaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceBackground: 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. <br/>
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. <br/>
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). <br/>
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.Okayama University Medical SchoolActa Medica Okayama0386-300X7422020Association between Histological Types and Enhancement of Dynamic CT for Primary Lung Cancer129135ENShogoFukumaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakayoshiShinyaDepartment of Radiology, Okayama University HospitalJunichiSohDepartment of General Thoracic Surgery, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesRyuichiroFukuharaDepartment of Pediatric Radiology, Okayama University HospitalNanakoOgawaDepartment of Radiology, Okayama University HospitalFumiyoHigakiDepartment of Radiology, Okayama City General Medical CenterTakehiroTanakaDepartment of Pathology, Okayama University HospitalEikiIchiharaDepartment of Allergy and Respiratory Medicine, Okayama University HospitalTakaoHirakiDepartment of Radiology, Okayama University HospitalShinichiToyookaDepartment of General Thoracic Surgery, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSusumuKanazawaDepartment of Radiology, Okayama University HospitalOriginal Article10.18926/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 SchoolActa Medica Okayama0386-300X7422020The Diagnostic Capacity of Pre-treatment 18F-FDG PET/CT for Predicting the Extranodular Spread of Lymph Node Metastases in Patients with Oral Squamous Cell Carcinoma123128ENRyuichiroFukuharaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakayoshiShinyaDepartment of Radiology, Okayama Diagnostic Imaging Center, Okayama university HospitalShogoFukumaDepartment of Radiology, Okayama Diagnostic Imaging Center, Okayama university HospitalNanakoOgawaDepartment of Radiology, Okayama Diagnostic Imaging Center, Okayama university HospitalYoshihisaMasaokaDepartment of Radiology, Okayama Diagnostic Imaging Center, Okayama university HospitalTakehiroTanakaDepartment of Pathology, Okayama Diagnostic Imaging Center, Okayama university HospitalHidenoriMarunakaDepartment of Otolaryngology-Head & Neck Surgery, Okayama Diagnostic Imaging Center, Okayama university HospitalTadashiAriokaDepartment of Radiology, Okayama Diagnostic Imaging Center, Okayama university HospitalTakaoHirakiDepartment of Radiology, Okayama Diagnostic Imaging Center, Okayama university HospitalMitsumasaKajiDepartment of Radiology, Okayama Diagnostic Imaging Center, Okayama university HospitalSusumuKanazawaDepartment of Radiology, Okayama Diagnostic Imaging Center, Okayama university HospitalOriginal Article10.18926/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.ElsevierActa Medica Okayama1930-04331462019Imaging an intrapulmonary solitary fibrous tumor with CT and F-18 FDG PET/CT755758ENTakayoshiShinyaDepartment of Pediatric Radiology, Okayama University HospitalYoshihisaMasaokaDepartment of Radiology, Okayama University HospitalMotohiroSandoDepartment of Radiology, Okayama University HospitalShinTanabeDepartment of Radiology, Okayama University HospitalSoichiroOkamotoDepartment of Radiology, Okayama University HospitalHirokiIharaDepartment of Radiology, Okayama University HospitalTakehiroTanakaDepartment of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShinjiOtaniDepartment of General Thoracic Surgery, Okayama University HospitalTakaoHirakiDepartment of Radiology, Okayama University HospitalSusumuKanazawaDepartment of Radiology, Okayama University HospitalIntrapulmonary 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 SchoolActa Medica Okayama0386-300X7062016Acute Bowel Injury due to Cryoablation for Renal Cell Carcinoma: Correlated Radiologic and Pathologic Findings511514ENHideoGobaraDepartment of Radiology,Okayama University HospitalTakaoHirakiDepartment of Radiology,Okayama University HospitalToshihiroIguchiDepartment of Radiology,Okayama University HospitalHiroyasuFujiwaraDepartment of Radiology,Okayama University HospitalTakeshiNagasakaDepartment of Gastroenterological Surgery, Okayama University HospitalHiroyukiKishimotoDepartment of Gastroenterological Surgery, Okayama University HospitalTakehiroTanakaDepartment of Pathology, Okayama University HospitalSusumuKanazawaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceCase Report10.18926/AMO/54817An 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 SchoolActa Medica Okayama0386-300X7042016Single Center Prospective Phase II Trial of CT-guided Radiofrequency Ablation for Pulmonary Metastases from Colorectal Cancer (SCIRO-1401)317321ENJunSakuraiCenter for Innovative Clinical Medicine, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Okayama University HospitalTakaoHirakiDepartment of Radiology, Okayama University HospitalToshihiroIguchiDepartment of Radiology, Okayama University HospitalHiroyasuFujiwaraDepartment of Radiology, Okayama University HospitalHideoGobaraDepartment of Radiology, Okayama University HospitalToshiharuMitsuhashiCenter for Innovative Clinical Medicine, Okayama University HospitalTakeshiNagasakaDepartment of Gastroenterological Surgery Transplant and Surgical Oncology, Okayama University HospitalSusumu KanazawaSusumu KanazawaDepartment of Radiology, Okayama University HospitalClinical Study Protocols10.18926/AMO/54512The 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 SchoolActa Medica Okayama0386-300X7042016Safety of Percutaneous Cryoablation in Patients with Painful Bone and Soft Tissue Tumors: A Single Center Prospective Study (SCIRO-1502)303306ENToshihiroIguchiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesJunSakuraiCenter for Innovative Clinical Medicine, Okayama University HospitalTakaoHirakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHideoGobaraDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHiroyasuFujiwaraDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYusukeMatsuiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYoshihisaMasaokaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSusumuKanazawaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesClinical Study Protocols10.18926/AMO/54509This 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 SchoolActa Medica Okayama0386-300X6922015Aggressive Multimodality Treatment for Advanced Rectal Cancer113118ENRyoInadaTakeshiNagasakaToshiakiToshimaYoshikoMoriYoshitakaKondoHiroyukiKishimotoTakaoHirakiTaiheiOshiroYukihideKanemitsuToshiyoshiFujiwaraCase Report10.18926/AMO/53340A case of advanced rectal cancer treated by aggressive local and systemic treatment who has survived more than 7 years from initial recurrence is presented. A 55-year-old woman was diagnosed with advanced lower rectal cancer and underwent a low anterior resection with complete removal of all regional lymph nodes and total mesorectal excision. The tumor was diagnosed as a moderately differentiated adenocarcinoma, pStage IIIB (T3, N2a, M0). Twenty-six months after the initial surgery, local recurrence in the pelvis was detected by computed tomography, and total pelvic exenteration with distal sacrectomy (TPES) was performed after systemic chemotherapy with a molecular-targeted drug. Six months after the TPES, multiple lung metastases were detected. Consequently, the patient underwent radiofrequency ablation (RFA) and chemotherapy. The disease has since been controlled for 38 months. As volume control is essential for cancer treatment, it may be important to combine appropriate local therapy with systemic therapy to metastatic or recurrent sites in order to achieve much longer disease control.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X5752003Percutaneous sclerotherapy for venous malformations using polidocanol under fluoroscopy.227234ENHidefumiMimuraSusumuKanazawaKotaroYasuiHiroyasuFujiwaraTsuyoshiHyodoTakashiMukaiShuichiDendoToshihiroIguchiTakaoHirakiIsaoKoshimaYoshioHirakiArticle10.18926/AMO/51909<p>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</p>No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6722013The Maximum Standardized Uptake Value Is More Reliable Than Size Measurement in Early Follow-up to Evaluate Potential Pulmonary Malignancies Following Radiofrequency Ablation105112ENAierkenAlafateTakayoshiShinyaYoshihiroOkumuraShuheiSatoTakaoHirakiHiroakiIshiiHideoGobaraKatsuyaKatoToshiyoshiFujiwaraShinichiroMiyoshiMitsumasaKajiSusumuKanazawaOriginal Article10.18926/AMO/49669We 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 SchoolActa Medica Okayama0386-300X6562011The 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 Ablation395402ENSosukeHaradaShuheiSatoEtsujiSuzukiYoshihiroOkumuraTakaoHirakiHideoGobaraHidefumiMimuraSusumuKanazawaMitsumasaKajiToshiyoshiFujiwaraOriginal Article10.18926/AMO/47265The 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 SchoolActa Medica Okayama0386-300X6552011Radiofrequency Ablation of Lung Cancer at Okayama University Hospital: A Review of 10 Years of Experience287297ENTakaoHirakiHideoGobaraHidefumiMimuraShinichiToyookaHiroyasuFujiwaraKotaroYasuiYoshifumiSanoToshihiroIguchiJunSakuraiNobuhisaTajiriTakashiMukaiYusukeMatsuiSusumuKanazawaReview10.18926/AMO/47010The 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 SchoolActa Medica Okayama0386-300X6132007Radiofrequency ablation followed by radiation therapy for large primary lung tumors177180ENTakashiMukaiHidefumiMimuraHideoGobaraMitsuhiroTakemotoKengoHimeiTakaoHirakiSoichiroHaseHiroyasuFujiwaraToshihiroIguchiNobuhisaTajiriJunSakuraiKotaroYasuiYoshifumiSanoHiroshiDateSusumuKanazawaCase Report10.18926/AMO/32906We 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 SchoolActa Medica Okayama0386-300X5822004Hepatic infarction following abdominal interventional procedures.97106ENHiroyasuFujiwaraSusumuKanazawaTakaoHirakiHidefumiMimuraKotaroYasuiShiroAkakiTakahitoYagiYoshioNaomotoNoriakiTanakaYoshioHirakiArticle10.18926/AMO/32095<p>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.</p>No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X5952005Hepatic 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.171178ENTakaoHirakiSusumuKanazawaLetter to the Editor10.18926/AMO/31975<p>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.</p>
No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6332009Infusion of Hypertonic Saline into the Lung Parenchyma during Radiofrequency Ablation of the Lungs with Multitined Expandable Electrodes:Results Using a Porcine Model137144ENTatsuhikoIishiTakaoHirakiHidefumiMimuraHideoGobaraTaichiKuroseHiroyasuFujiwaraJunSakuraiHiroyukiYanaiTadashiYoshinoSusumuKanazawaOriginal Article10.18926/AMO/31848<p>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.</p>No potential conflict of interest relevant to this article was reported.‰ªŽRˆãŠw‰ïActa Medica Okayama0030-155812212010ŒŒŠÇŽîEŒŒŠÇŠïŒ`‚ɑ΂·‚éinterventional radiology5559ENHidefumiMimuraHiroyasuFujiwaraTakaoHirakiHideoGobaraKentaroShibamotoYoshihiroKimataToshifumiOzakiSatoruSasakiSusumuKanazawaNo potential conflict of interest relevant to this article was reported.‰ªŽRˆãŠw‰ïActa Medica Okayama0030-155811822006‹CŠÇ—â‹p‰º‚ÉŽ{s‚µ‚½cŠuƒŠƒ“ƒpß“]ˆÚ‚ɑ΂·‚郉ƒWƒI”gĎܗÖ@105108ENNo potential conflict of interest relevant to this article was reported.Acta Medica Okayama2001Altered Hemodynamics in the Liver Caused by Temporary Occlusion of the Hepatic Vein: Evaluation with Doppler Ultrasonography in 14 PatientsENNo potential conflict of interest relevant to this article was reported.