研究者詳細 - 陣崎　雅弘

論文 - 陣崎　雅弘

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特集腎・泌尿器の画像診断update 前立腺癌のMRI 診断

有田祐起, 玉田勉, 池田織人, 陣崎雅弘

画像診断（学研メディカル秀潤社） 40 （ 6 ） 521 - 532 2020年04月

ISSN 0285-0524

特集腎・泌尿器の画像診断update 腎腫瘍の画像診断

秋田大宇, 池田織人, 若井理可子, 陣崎雅弘

画像診断（学研メディカル秀潤社） 40 （ 6 ） 565 - 576 2020年04月

ISSN 0285-0524

In vivo monitoring of remnant undifferentiated neural cells following human induced pluripotent stem cell-derived neural stem/progenitor cells transplantation

Tanimoto Y., Yamasaki T., Nagoshi N., Nishiyama Y., Nori S., Nishimura S., Iida T., Ozaki M., Tsuji O., Ji B., Aoki I., Jinzaki M., Matsumoto M., Fujibayashi Y., Zhang M.R., Nakamura M., Okano H.

Stem Cells Translational Medicine （Stem Cells Translational Medicine） 9 （ 4 ） 465 - 477 2020年04月

ISSN 21576564

© 2020 The Authors. Stem Cells Translational Medicine published by Wiley Periodicals, Inc. on behalf of AlphaMed Press Transplantation of human-induced pluripotent stem cell-derived neural stem/progenitor cells (hiPSC-NS/PCs) is a promising treatment for a variety of neuropathological conditions. Although previous reports have indicated the effectiveness of hiPSC-NS/PCs transplantation into the injured spinal cord of rodents and nonhuman primates, long-term observation of hiPSC-NS/PCs post-transplantation suggested some “unsafe” differentiation-resistant properties, resulting in disordered overgrowth. These findings suggest that, even if “safe” NS/PCs are transplanted into the human central nervous system (CNS), the dynamics of cellular differentiation of stem cells should be noninvasively tracked to ensure safety. Positron emission tomography (PET) provides molecular-functional information and helps to detect specific disease conditions. The current study was conducted to visualize Nestin (an NS/PC marker)-positive undifferentiated neural cells in the CNS of immune-deficient (nonobese diabetic-severe combined immune-deficient) mice after hiPSC-NS/PCs transplantation with PET, using 18 kDa translocator protein (TSPO) ligands as labels. TSPO was recently found to be expressed in rodent NS/PCs, and its expression decreased with the progression of neuronal differentiation. We hypothesized that TSPO would also be present in hiPSC-NS/PCs and expressed strongly in residual immature neural cells after transplantation. The results showed high levels of TSPO expression in immature hiPSC-NS/PCs-derived cells, and decreased TSPO expression as neural differentiation progressed in vitro. Furthermore, PET with [18F] FEDAC (a TSPO radioligand) was able to visualize the remnant undifferentiated hiPSC-NS/PCs-derived cells consisting of TSPO and Nestin+ cells in vivo. These findings suggest that PET with [18F] FEDAC could play a key role in the safe clinical application of CNS repair in regenerative medicine.

Silent MRA: arterial spin labeling magnetic resonant angiography with ultra-short time echo assessing cerebral arteriovenous malformation

Arai N., Akiyama T., Fujiwara K., Koike K., Takahashi S., Horiguchi T., Jinzaki M., Yoshida K.

Neuroradiology （Neuroradiology） 62 （ 4 ） 455 - 461 2020年04月

ISSN 00283940

© 2020, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: MR angiography using the silent MR angiography algorithm (silent MRA), which combines arterial spin labeling and an ultrashort time echo, has not been used for the evaluation of cerebral arteriovenous malformations (CAVMs). We aimed to determine the usefulness of silent MRA for the evaluation of CAVMs. Methods: Twenty-nine CAVMs of 28 consecutive patients diagnosed by 4D CT angiography or digital subtraction angiography, who underwent both time-of-flight (TOF) MRA and silent MRA, were enrolled. Two observers independently assessed the TOF-MRA and silent MRA images of CAVMs. Micro AVM was defined as AVM with a nidus diameter less than 10 mm. The detection rate, visualization of the components, and accuracy of Spetzler–Martin grade were evaluated with statistical software R. Results: For all 29 CAVMs, 23 (79%) lesions were detected for TOF-MRA and all for silent MRA. Of 10 micro AVMs, only 4 (40%) lesions were detectable on TOF-MRA and all (100%) on silent MRA. The visibility of the nidus and drainer was significantly better for silent MRA than TOF-MRA (p < 0.001), while there was no significant difference in the feeder between the two sequences. The accuracy rates of the Spetzler–Martin grade for the TOF and silent MRA were 38% (11/29) and 79.3% (23/29), respectively (p < 0.001). Conclusions: Silent MRA is useful for evaluating CAVM components and detecting micro AVM.

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Analysis of the superficial middle cerebral vein in sphenoid ridge meningioma using contrast-enhanced dynamic computed tomography angiography

Murase M., Mizutani K., Kawata K., Fujiwara H., Jinzaki M., Toda M., Yoshida K.

Clinical Neurology and Neurosurgery （Clinical Neurology and Neurosurgery） 191 2020年04月

ISSN 03038467

© 2020 Objective: The superficial middle cerebral vein (SMCV) is of clinical importance because of its contribution to the venous drainage of the superficial part of the cerebrum. Sphenoid ridge meningioma (SRM) grows adjacent to the SMCV and its drainage routes, and is thought to occasionally influence the hemodynamics of the SMCV, although this has seldom been suggested in the literature. We investigated the effect of SRM on the SMCV via blood flow analysis using multi-detector computed tomography. Patients and Methods: Overall, 22 patients with SRM who preoperatively underwent contrast-enhanced dynamic computed tomography at our institution were included in this study. We serially measured the Hounsfield units at each point of the SMCV and its adjacent veins on the side on which the tumor was located. We then obtained a time-density curve for each point via gamma distribution fitting. We determined the time-to-peak at each point by calculating the derivative of the time-density curve function and deduced the direction of blood passing through each vein by comparing the time-to-peak values between several points. Results: In total, 26 SMCVs were measured in 19 out of 22 cases. Of the 26 SMCVs, 16 were patent in the medial portion and contributed to normal venous drainage: 4 of them emptied into the cavernous sinus (CS), and 12 of them into the para-cavernous sinus (ParaCS). Out of the 10 that had their medial portions occluded because of the effects of the tumor, 6 SMCVs mainly drained into the vein of Labbé and/or the vein of Trolard retrogradely. However, in 2 of these, the small medial portions of the SMCVs near the occluded portion were maintained anterogradely by the collateral venous structures. In 4 SMCVs, the blood flow through the collateral veins remained anterograde; this was considered to contribute to normal venous drainage. Conclusion: The SRM is likely to cause occlusion or stenosis in the SMCV and influence its hemodynamics. In cases in which the connection between the SMCV and the CS or the ParaCS has been lost, the SMCV may still be involved in normal venous drainage via the collateral veins in some of those cases. Thus, the contribution of these veins to normal venous drainage in the brain should be analyzed preoperatively in careful detail.

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特集画像診断における脂肪の意味:存在からその意義まで泌尿器疾患

秋田大宇, 若井理可子, 陣崎雅弘

臨床画像（メジカルビュー社） 36 （ 3 ） 266 - 279 2020年03月

ISSN 0911-1069

Efficacy of a topical gelatin-thrombin hemostatic matrix, FLOSEAL®, in intracranial tumor resection

Kamamoto D., Kanazawa T., Ishihara E., Yanagisawa K., Tomita H., Ueda R., Jinzaki M., Yoshida K., Toda M.

Surgical Neurology International （Surgical Neurology International） 11 （ 16 ） 2020年02月

© 2020 Scientific Scholar. All rights reserved. Background: Hemostasis plays an important role in safe brain tumor resection and also reduces the risk for surgical complications. This study aimed to evaluate the efficacy of FLOSEAL®, a topical hemostatic agent that contains thrombin and gelatin granules, in brain tumor resections. Methods: We evaluated the hemostatic effect of FLOSEAL by scoring the intensity of bleeding from 1 (mild) to 4 (life threatening). We assessed the rate of success of hemostasis with 100 patients who underwent intracranial tumor resection. We also investigated the duration of the operation, the amount of intra- and postoperative bleeding, the number of hospital stays, and adverse events in patients who used FLOSEAL compared with those who did not use FLOSEAL. Results: FLOSEAL was applied to a total of 109 bleeding areas in 100 patients. A total of 95 bleeding areas had a score of 1 and 91 (96%) showed successful hemostasis. Thirteen bleeding areas scored 2 and 8 (62%) showed hemostasis with the first application of FLOSEAL. The second application was attempted with five bleeding areas and four showed hemostasis. About 94% (103/109 areas) of bleeding points successfully achieved hemostasis by FLOSEAL. Moreover, FLOSEAL significantly decreased the amount of intraoperative bleeding and postoperative bleeding as assessed with computed tomography on 1 day postoperatively compared with no use of FLOSEAL. There were no adverse events related to FLOSEAL use. Conclusion: Our results indicate that FLOSEAL is a reliable, convenient, and safe topical hemostatic agent for intracranial tumor resection.

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Development of Upright Computed Tomography with Area Detector for Whole-Body Scans: Phantom Study, Efficacy on Workflow, Effect of Gravity on Human Body, and Potential Clinical Impact

Jinzaki M., Yamada Y., Nagura T., Nakahara T., Yokoyama Y., Narita K., Ogihara N., Yamada M.

Investigative Radiology （Investigative Radiology） 55 （ 2 ） 73 - 83 2020年02月

ISSN 00209996

© Wolters Kluwer Health, Inc. All rights reserved. Objectives Multiple human systems are greatly affected by gravity, and many disease symptoms are altered by posture. However, the overall anatomical structure and pathophysiology of the human body while standing has not been thoroughly analyzed due to the limitations of various upright imaging modalities, such as low spatial resolution, low contrast resolution, limited scan range, or long examination time. Recently, we developed an upright computed tomography (CT), which enables whole-torso cross-sectional scanning with 3-dimensional acquisition within 15 seconds. The purpose of this study was to evaluate the performance, workflow efficacy, effects of gravity on a large circulation system and the pelvic floor, and potential clinical impact of upright CT. Materials and Methods We compared noise characteristics, spatial resolution, and CT numbers in a phantom between supine and upright CT. Thirty-two asymptomatic volunteers (48.4 ± 11.5 years) prospectively underwent both CT examinations with the same scanning protocols on the same day. We conducted a questionnaire survey among these volunteers who underwent the upright CT examination to determine their opinions regarding the stability of using the pole throughout the acquisition (closed question), as well as safety and comfortability throughout each examination (both used 5-point scales). The total access time (sum of entry time and exit time) and gravity effects on a large circulation system and the pelvic floor were evaluated using the Wilcoxon signed-rank test and the Mann-Whitney U test. For a large circulation system, the areas of the vena cava and aorta were evaluated at 3 points (superior vena cava or ascending aorta, at the level of the diaphragm, and inferior vena cava or abdominal aorta). For the pelvic floor, distances were evaluated from the bladder neck to the pubococcygeal line and the anorectal junction to the pubococcygeal line. We also examined the usefulness of the upright CT in patients with functional diseases of spondylolisthesis, pelvic floor prolapse, and inguinal hernia. Results Noise characteristics, spatial resolution, and CT numbers on upright CT were comparable to those of supine CT. In the volunteer study, all volunteers answered yes regarding the stability of using the pole, and most reported feeling safe (average rating of 4.2) and comfortable (average rating of 3.8) throughout the upright CT examination. The total access time for the upright CT was significantly reduced by 56% in comparison with that of supine CT (upright: 41 ± 9 seconds vs supine: 91 ± 15 seconds, P < 0.001). In the upright position, the area of superior vena cava was 80% smaller than that of the supine position (upright: 39.9 ± 17.4 mm2 vs supine: 195.4 ± 52.2 mm2, P < 0.001), the area at the level of the diaphragm was similar (upright: 428.3 ± 87.9 mm2 vs supine: 426.1 ± 82.0 mm2, P = 0.866), and the area of inferior vena cava was 37% larger (upright: 346.6 ± 96.9 mm2 vs supine: 252.5 ± 93.1 mm2, P < 0.001), whereas the areas of aortas did not significantly differ among the 3 levels. The bladder neck and anorectal junction significantly descended (9.4 ± 6.0 mm and 8.0 ± 5.6 mm, respectively, both P < 0.001) in the standing position, relative to their levels in the supine position. This tendency of the bladder neck to descend was more prominent in women than in men (12.2 ± 5.2 mm in women vs 6.7 ± 5.6 mm in men, P = 0.006). In 3 patients, upright CT revealed lumbar foraminal stenosis, bladder prolapse, and inguinal hernia; moreover, it clarified the grade or clinical significance of the disease in a manner that was not apparent on conventional CT. Conclusions Upright CT was comparable to supine CT in physical characteristics, and it significantly reduced the access time for examination. Upright CT was useful in clarifying the effect of gravity on the human body: Gravity differentially affected the volume and shape of the vena cava, depending on body position. The pelvic floor descended significantly in the standing position, compared with its location in the supine position, and the descent of the bladder neck was more prominent in women than in men. Upright CT could potentially aid in objective diagnosis and determination of the grade or clinical significance of common functional diseases.

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Prediction of postoperative recurrence of chronic subdural hematoma using quantitative volumetric analysis in conjunction with computed tomography texture analysis

Kanazawa T., Takahashi S., Minami Y., Jinzaki M., Toda M., Yoshida K.

Journal of Clinical Neuroscience （Journal of Clinical Neuroscience） 72 270 - 276 2020年02月

ISSN 09675868

© 2019 Elsevier Ltd Chronic subdural hematoma (CSDH) is a common disease in older individuals with a substantial rate of recurrence. The mechanism of CSDH recurrence remains unclear. This study aimed to detect imaging parameters that could indicate the risk for CSDH recurrence by using quantitative volumetric analysis and computed tomography (CT) texture analysis (CTTA). Clinical and imaging parameters were retrospectively investigated in 147 newly diagnosed CSDH lesions in 114 patients surgically treated at the Keio University Hospital during a 6-year period. For CT images, quantitative volumetric and texture analyses were performed. Hematoma volume, postoperative air volume, hematoma density, and texture parameters including kurtosis, skewness, and entropy were evaluated and compared with CSDH recurrence rate. Data were statistically evaluated, and a difference of p < 0.05 was considered significant. Reoperation for CSDH recurrence was required in 27 sides (18.4%) of 26 patients. Multivariate analysis showed that postoperative hematoma volume and postoperative hematoma density were independent risk factors for symptomatic CSDH recurrence that required reoperation. Postoperative hematoma volume, postoperative significant residual air, and postoperative hematoma density were also identified as independent risk factors for potential CSDH recurrence. Preoperative hematoma entropy was prone to be associated with both symptomatic and potential CSDH recurrence in univariate analysis, but not in multivariate analysis because of confounding factors. Quantitative volumetric analysis and CTTA could aid in distinguishing individuals at risk for CSDH recurrence.

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特集胸部の最新画像情報2020 症例肺トキソカラ症の1例

児玉さゆり, 杉浦弘明, 成松英俊, 渡邉浩美, 大熊潔, 川田真幹, 陣崎雅弘

臨床放射線（金原出版） 65 （ 1 ） 25 - 28 2020年01月

ISSN 0009-9252

特集胸部の最新画像情報2020 症例肺野の画像所見が診断の契機となったEhlers-Danlos症候群の1例

松本晋作, 杉浦弘明, 南康大, 山田祥岳, 渡辺理沙, 福永興壱, 陣崎雅弘

臨床放射線（金原出版） 65 （ 1 ） 67 - 70 2020年01月

ISSN 0009-9252

Disclosure of Amyloid Status for Risk of Alzheimer Disease to Cognitively Normal Research Participants With Subjective Cognitive Decline: A Longitudinal Study

Wake T., Tabuchi H., Funaki K., Ito D., Yamagata B., Yoshizaki T., Nakahara T., Jinzaki M., Yoshimasu H., Tanahashi I., Shimazaki H., Mimura M.

American journal of Alzheimer's disease and other dementias （American journal of Alzheimer's disease and other dementias） 35 153331752090455 2020年01月

ISSN 15333175

This study aimed to investigate the long-term impacts of disclosing amyloid status for a risk of Alzheimer disease (AD) to cognitively normal research participants with subjective cognitive decline (SCD), which represents an initial manifestation of AD. Forty-two participants were classified as the amyloid-positive (n = 10) or amyloid-negative (n = 32) groups. We assessed symptoms of anxiety, depression, and test-related distress at 6, 24, and 52 weeks after results disclosure. No difference was found over time in anxiety, depression, and test-related distress in either group. Although no significant differences were observed between groups in anxiety or depression, the amyloid-negative group had a significantly higher level of test-related distress than the amyloid-positive group at 52 weeks. Disclosing amyloid status to cognitively healthy research participants with SCD did not cause significant long-term psychological risks. However, a theoretical spectrum of subjective concern may exist about cognitive decline in amyloid-negative individuals.

Early prediction of clinical outcomes in patients with aneurysmal subarachnoid hemorrhage using computed tomography texture analysis

Kanazawa T., Takahashi S., Minami Y., Jinzaki M., Toda M., Yoshida K.

Journal of Clinical Neuroscience （Journal of Clinical Neuroscience） 71 144 - 149 2020年01月

ISSN 09675868

© 2019 Elsevier Ltd Radiological evaluation of subarachnoid hemorrhage (SAH) is often subject to interobserver variability. The aim of this study was to retrospectively detect computed tomography (CT) texture parameters in the early postictal state to predict cerebral vasospasm, delayed cerebral ischemia (DCI), and functional outcome in aneurysmal SAH using quantitative CT texture analysis (CTTA) via a commercially available software program and routine CT images. 40 patients with aneurysmal SAH surgically treated at the Keio University Hospital during a four-year period were analyzed. CT texture analyses were performed using a commercially available software program (Synapse Vincent). The following texture parameters of blood clots in the subarachnoid space and cerebral edema were assessed: mean CT value, entropy, skewness, and kurtosis. The mean CT value of blood clots in the subarachnoid space was significantly associated with cerebral vasospasm, DCI, and functional outcome. The mean CT value ≥ 49.64 Hounsfield units (HU) predicted cerebral vasospasm with a sensitivity and specificity of 85.7% and 61.5%, respectively (area under the curve [AUC] = 0.758). The mean CT value ≥ 49.95 HU predicted DCI with a sensitivity and specificity of 100% and 60.6%, respectively (AUC = 0.810). The mean CT value ≥ 53.00 HU predicted poor functional outcome with a sensitivity and specificity of 56.3% and 91.7%, respectively (AUC = 0.747). CTTA using a commercially available software program demonstrated that the mean CT value of clots in the subarachnoid space in the early postictal state could predict vasospasm, DCI, and clinical outcome with a high sensitivity and specificity.

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【胸部の最新画像情報2020】肺トキソカラ症の1例

児玉さゆり, 杉浦弘明, 成松英俊, 渡邉浩美, 大熊潔, 川田真幹, 陣崎雅弘

臨床放射線（金原出版(株)） 65 （ 1 ） 25 - 28 2020年01月

ISSN 0009-9252

症例は20歳代女性で、後頸部から後頭部痛を主訴に近医を受診し、化膿性脊椎炎の疑いで当院整形外科を紹介受診した。頸部MRIでは頸椎に有意な所見を認めなかった。血液検査では好酸球増多を認め、内科で精査の方針となり入院した。入院10日目に再度CT検査を施行したところ、初回CT検査と比較してすりガラス影、小結節状陰影は消退しており、一部に新規出現を認めた。抗寄生虫抗体スクリーニング検査では、ブタ回虫がクラス2と弱陽性、糞線虫がクラス1と偽陽性であった。そこで抗体定量検査を追加したところ、ブタ回虫や糞線虫に対する抗体価の上昇はなく、トキソカラに対する抗体価が有意に上昇しており、トキソカラ症と診断した。CT画像もトキソカラ症と合致する所見であった。albendazoleの内服は行わずに経過観察の方針となった。その後、再受診することなく経過している。

【胸部の最新画像情報2020】肺野の画像所見が診断の契機となったEhlers-Danlos症候群の1例

松本晋作, 杉浦弘明, 南康大, 山田祥岳, 渡辺理沙, 福永興壱, 陣崎雅弘

臨床放射線（金原出版(株)） 65 （ 1 ） 67 - 70 2020年01月

ISSN 0009-9252

症例は40歳代女性で、胸痛を主訴に近医を受診し、胸部単純X線で左気胸を指摘され当院へ紹介入院となった。胸部単純CTにて左気胸を認めた。両肺底部に複数の不整な嚢胞、両下葉に浸潤影、小葉中心性陰影および気管支拡張を認めた。なお、約1年前の肺炎時のCTでは嚢胞は認められなかった。胸腔ドレーンを留置するも気胸およびリークの改善を認めなかったため、胸腔鏡下左肺下葉嚢胞切除術を施行した。術後経過は良好で、術後約1週間で退院した。比較的若年者に繰り返す肺炎後に不整な嚢胞が散見され、難治性の気胸を発症したことから肺組織の脆弱性が示唆され、基礎疾患としてEhlers-Danlos症候群の可能性が疑われた。遺伝子検査ではCOL5A2遺伝子変異が陽性(ミスセンス変異)であり、古典型Ehlers-Danlos症候群と診断された。また、COL3A1遺伝子変異は陰性であったことから、血管型Ehlers-Danlos症候群は否定された。

Comparison of silent navigator waveform generation methods

Iwadate Y., Nozaki A., Nunokawa Y., Okuda S., Kabasawa H., Jinzaki M.

Magnetic Resonance in Medical Sciences （Magnetic Resonance in Medical Sciences） 19 （ 2 ） 154 - 158 2020年

ISSN 13473182

© 2019 Japanese Society for Magnetic Resonance in Medicine. The silent navigator technique utilizes a non-selective excitation and an appropriate respiratory waveform generation method is necessary for an accurate motion detection. We compared three methods for silent navigator waveform generation. The profile generation method with coil selection (prof-selection) resulted in a high cross correlation with bellows signals and a large respiration amplitude. The prof-selection method should be used for silent navigator waveform generation.

Usefulness of fine-tuning for deep learning based multi-organ regions segmentation method from non-contrast CT volumes using small training dataset

Hayashi Y., Shen C., Roth H.R., Oda M., Misawa K., Jinzaki M., Hashimoto M., Kumamaru K.K., Aoki S., Mori K.

Progress in Biomedical Optics and Imaging - Proceedings of SPIE （Progress in Biomedical Optics and Imaging - Proceedings of SPIE） 11314 2020年

ISSN 9781510633957

© 2020 SPIE. This paper presents segmentation of multiple organ regions from non-contrast CT volume based on deep learning. Also, we report usefulness of fine-tuning using a small number of training data for multi-organ regions segmentation. In medical image analysis system, it is vital to recognize patient specific anatomical structures in medical images such as CT volumes. We have studied on a multi-organ regions segmentation method from contrast-enhanced abdominal CT volume using 3D U-Net. Since non-contrast CT volumes are also usually used in the medical field, segmentation of multi-organ regions from non-contrast CT volume is also important for the medical image analysis system. In this study, we extract multi-organ regions from non-contrast CT volume using 3D U-Net and a small number of training data. We perform fine-tuning from a pre-trained model obtained from the previous studies. The pre-trained 3D U-Net model is trained by a large number of contrast enhanced CT volumes. Then, fine-tuning is performed using a small number of non-contrast CT volumes. The experimental results showed that the fine-tuned 3D U-Net model could extract multi-organ regions from non-contrast CT volume. The proposed training scheme using fine-tuning is useful for segmenting multi-organ regions using a small number of training data.

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Successful depiction of systemic collateral supply to pulmonary artery in CTEPH using time-resolved 4D CT angiography: a case report

Tamura M., Kawakami T., Yamada Y., Kataoka M., Nakatsuka S., Fukuda K., Jinzaki M.

Pulmonary Circulation （Pulmonary Circulation） 10 （ 2 ） 2020年

ISSN 20458932

© The Author(s) 2020. A 49-year-old man with CTEPH (pre-procedural mean pulmonary artery pressure: 36 mmHg) underwent balloon pulmonary angioplasty. Chronic total occlusion of the left inferior pulmonary artery trunk was observed. To evaluate the collateral vessels of the chronic total occlusion, 4D-CTA was performed. The examination was performed using a 256-row detector CT system using the test bolus tracking method. 4D-CTA showed the bronchial artery-to-left inferior pulmonary artery collateral supply, which was confirmed by a selective bronchial artery angiography. The patient’s symptoms improved with balloon pulmonary angioplasty of the other stenotic lesions. 4D-CTA can noninvasively evaluate the anatomy and hemodynamics of multiple systemic collaterals simultaneously. This technique can support interventions in systemic artery-to-pulmonary artery collaterals, such as embolization, and could be helpful in challenging balloon pulmonary angioplasty interventions for chronic total occlusion to identify vessel structures distal to the chronic total occlusion and collateral channels for a retrograde approach.

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Sinking skin flap syndrome visualized by upright computed tomography

Yoshida K., Toda M., Yamada Y., Yamada M., Yokoyama Y., Fujiwara H., Kosugi K., Fukumura M., Koike K., Takahashi S., Yoshida K., Jinzaki M.

Acta Neurochirurgica （Acta Neurochirurgica） 162 （ 8 ） 1825 - 1828 2020年

ISSN 00016268

© 2020, Springer-Verlag GmbH Austria, part of Springer Nature. Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves after cranioplasty. We present a 33-year-old man who experienced hemiparesis in the upright position after craniectomy. Upright computed tomography (CT) before cranioplasty showed a remarkable shift of the brain compared to supine CT. After cranioplasty, both symptoms and brain shift on CT resolved. Upright CT enables detection and objective evaluation of paradoxical herniation and midline shift that is not obvious on supine imaging modalities. Clinicians need to be aware of positional brain shift in postcraniectomy patients.

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Quantitative analysis of intervertebral disc degeneration using Q-space imaging in a rat model

Nakashima D., Fujita N., Hata J., Komaki Y., Suzuki S., Nagura T., Fujiyoshi K., Watanabe K., Tsuji T., Okano H., Jinzaki M., Matsumoto M., Nakamura M.

Journal of Orthopaedic Research （Journal of Orthopaedic Research） 38 （ 10 ） 2220 - 2229 2020年

ISSN 07360266

© 2020 Orthopaedic Research Society. Published by Wiley Periodicals LLC The degree of intervertebral disc (IVD) degeneration is qualitatively evaluated on T2-weighted imaging (T2WI). However, it is difficult to assess subtle changes in IVD degeneration using T2WI. Q-space imaging (QSI) is a quantitative diffusion-weighted imaging modality used to detect subtle changes in microenvironments. This study aimed to evaluate whether QSI can detect the inhibitory effects of the antioxidant N-acetylcysteine (NAC) in IVD degeneration. We classified female Wistar rats into control, puncture, and NAC groups (n = 5 per group). In the puncture and NAC groups, IVDs were punctured using a needle. The antioxidant NAC, which suppresses the progression of IVD degeneration, was orally administered in the NAC group 1 week prior to puncture. The progression and inhibitory effect of NAC in IVD degeneration were assessed using magnetic resonance imaging (MRI): IVD height, T2 mapping, apparent diffusion coefficient (ADC), and QSI. MRI was performed using a 7-Tesla system with a conventional probe (20 IVDs in each group). QSI parameters that were assessed included Kurtosis, the probability at zero displacement (ZDP), and full width at half maximum (FWHM). IVD degeneration by puncture was confirmed by histology, IVD height, T2 mapping, ADC, and all QSI parameters (P <.001); however, the inhibitory effect of NAC was confirmed only by QSI parameters (Kurtosis and ZDP: both P <.001; FWHM: P <.01). Kurtosis had the largest effect size (Kurtosis: 1.13, ZDP: 1.06, and FWHM: 1.02) when puncture and NAC groups were compared. QSI has a higher sensitivity than conventional quantitative methods for detecting the progressive change and inhibitory effect of NAC in IVD degeneration.

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