Publications by authors named "Kazunari Ishii"

160 Publications

Correction: Isao N., et al. Transcatheter Arterial Embolization Treatment for Bleeding Visceral Artery Pseudoaneurysms in Patients with Pancreatitis or Following Pancreatic Surgery. 2020, , 2733.

Cancers (Basel) 2021 Mar 15;13(6). Epub 2021 Mar 15.

Department of Diagnostic Radiology, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo 650-0017, Japan.

The authors are sorry to report that the overall survival reported in their recently published paper was incorrect [...].
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http://dx.doi.org/10.3390/cancers13061312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001708PMC
March 2021

Attenuation correction using deep learning for brain perfusion SPECT images.

Ann Nucl Med 2021 Mar 9. Epub 2021 Mar 9.

Division of Positron Emission Tomography, Institute of Advanced Clinical Medicine, Kindai University, Osaka, 589-8511, Japan.

Objective: Non-uniform attenuation correction using computed tomography (CT) improves the image quality and quantification of single-photon emission computed tomography (SPECT). However, it is not widely used because it requires a SPECT/CT scanner. This study constructs a convolutional neural network (CNN) to generate attenuation-corrected SPECT images directly from non-attenuation-corrected SPECT images.

Methods: We constructed an auto-encoder (AE) using a CNN to correct the attenuation in brain perfusion SPECT images. SPECT image datasets of 270 (44,528 slices including augmentation), 60 (5002 slices), and 30 (2558 slices) cases were used for training, validation, and testing, respectively. The acquired projection data were reconstructed in three patterns: uniform attenuation correction using Chang's method (Chang-AC), non-uniform attenuation correction using CT (CT-AC), and no attenuation correction (No-AC). The AE learned an end-to-end mapping between the No-AC and CT-AC images. The No-AC images in the test dataset were loaded into the trained AE, which generated images simulating the CT-AC images as output. The generated SPECT images were employed as attenuation-corrected images using the AE (AE-AC). The accuracy of the AE-AC images was evaluated in terms of the peak signal-to-noise ratio (PSNR) and the structural similarity metric (SSIM). The intensities of the AE-AC and CT-AC images were compared by voxel-by-voxel and region-by-region analysis.

Results: The PSNRs of the AE-AC and Chang-AC images, compared using CT-AC images, were 62.2, and 57.9, and their SSIM values were 0.9995 and 0.9985, respectively. The AE-AC and CT-AC images were visually and statistically in good agreement.

Conclusions: The proposed AE-AC method yields highly accurate attenuation-corrected brain perfusion SPECT images.
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http://dx.doi.org/10.1007/s12149-021-01600-zDOI Listing
March 2021

Primary diaphragmatic clear cell carcinoma associated with endometriosis: A case report and literature review.

Gynecol Oncol Rep 2021 May 19;36:100733. Epub 2021 Feb 19.

Department of Pathology, Kindai University Faculty of Medicine, Osakasayama-city, Osaka, Japan.

Diaphragmatic endometriosis is extremely rare. Although endometriosis is considered generally benign, malignant transformation of endometriosis was reported in 1925. Multiple studies have since described clear cell carcinoma (CCC) or endometrioid carcinoma arising from ovarian endometriosis. Previously, only two reports of primary diaphragmatic CCC were reported, in which coexistent endometriosis with CCC was not histologically proven. We report a case of a 55-year-old postmenopausal woman who was admitted to Kindai university hospital for the examination of a cystic mass with papillary components in the right diaphragm. On her past medical history, abdominal hysterectomy and bilateral salpingo-oophorectomy was performed for high-grade cervical intraepithelial neoplasia, uterine myoma, and bilateral ovarian endometriosis 5 years ago. Unenhanced CT performed 5 years ago, showed a nodular lesion with low density in the right diaphragm, consistent with diaphragmatic endometriosis. Magnetic resonance imaging during this admission, showed a cystic mass with papillary components in the right diaphragm and a T2*-weighted gradient echo imaging showed partial low signal intensity in the papillary components and cyst wall, which was suspected to represent hemosiderin deposition. Based on these serial images, malignant transformation of diaphragmatic endometriosis was suspected. Under, open abdominal combined resection of the mass and part of the diaphragm was performed. Endometriosis implants were detected on the pelvic peritoneum. Histopathological examination revealed clear cell carcinoma associated with endometriosis and hemosiderin deposition in the cyst wall. T2*-weighted gradient echo imaging was useful in the detection of hemosiderin deposition caused by the coexistent endometriosis. When a cystic mass with papillary components and cyst wall with hemosiderin deposits are encountered on MR images, malignant transformation of endometriosis is suspected and a detailed medical history should be determined and the possibility of concurrent endometriosis or adenomyosis should be investigated, as should the potential existence of diaphragmatic endometriosis in previous images.
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http://dx.doi.org/10.1016/j.gore.2021.100733DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906886PMC
May 2021

Improving contrast between gray and white matter of Logan graphical analysis' parametric images in positron emission tomography through least-squares cubic regression and principal component analysis.

Biomed Phys Eng Express 2021 Mar 4. Epub 2021 Mar 4.

Department of Electrical Engineering and Electronics, Graduate School of Engineering, Kogakuin University, 1-24-2 Nishi-shinjuku, Shinjuku-ku, Tokyo, 163-8677, JAPAN.

Logan graphical analysis (LGA) is a method for in vivo quantification of tracer kinetics in positron emission tomography (PET). The shortcoming of LGA is the presence of a negative bias in the estimated parameters for noisy data. Various approaches have been proposed to address this issue. We recently applied an alternative regression method called least-squares cubic (LSC), which considers the errors in both the predictor and response variables to estimate the LGA slope. LSC reduced the bias in non-displaceable binding potential estimates while causing slight increases in the variance. In this study, we combined LSC with a principal component analysis (PCA) denoising technique to counteract the effects of variance on parametric image quality, which was assessed in terms of the contrast between gray and white matter. Tissue time-activity curves were denoised through PCA, prior to estimating the regression parameters using LSC. We refer to this approach as LSC-PCA. LSC-PCA was assessed against OLS-PCA (PCA with ordinary least-squares (OLS)), LSC, and conventional OLS-based LGA. Comparisons were made for simulatedC-carfentanil andC Pittsburgh compound B (C-PiB) data, and clinicalC-PiB PET images. PCA-based methods were compared over a range of principal components, varied by the percentage variance they account for in the data. The results showed reduced variances in distribution volume ratio estimates in the simulations for LSC-PCA compared to LSC, and lower bias compared to OLS-PCA and OLS. Contrasts were not significantly improved in clinical data, but they showed a significant improvement in simulation data |indicating a potential advantage of LSC-PCA over OLS-PCA. The effects of bias reintroduction when many principal components are used were also observed in OLS-PCA clinical images. We therefore encourage the use of LSC-PCA. LSC-PCA can allow the use of many principal components with minimal risk of bias, thereby strengthening the interpretation of PET parametric images.
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http://dx.doi.org/10.1088/2057-1976/abec18DOI Listing
March 2021

Distinctive regional asymmetry in dopaminergic and serotoninergic dysfunction in degenerative Parkinsonisms.

J Neurol Sci 2021 04 23;423:117363. Epub 2021 Feb 23.

Department of Neurology, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Hyogo, Japan.

Purpose: This study aimed to identify regional asymmetry in dopaminergic and serotoninergic dysfunction in degenerative parkinsonisms, using dopamine transporter single-photon emission computed tomography images.

Material And Methods: This study included 213 consecutive participants (Parkinson's disease [n = 111], dementia with Lewy bodies [n = 64], progressive supranuclear palsy with Richardson's syndrome [n = 18], and healthy participants [n = 20]) who underwent both magnetic resonance imaging and I-labelled 2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane single-photon emission computed tomography/computed tomography. Using normalized specific binding ratio images, we created voxel-wise regional asymmetry index images to identify the regional specific pattern of regional asymmetries in degenerative parkinsonisms.

Results: Compared with healthy controls, patients with Parkinson's disease showed a regional asymmetry index increase in the nigrostriatal dopaminergic pathway, and those with dementia with Lewy bodies showed a regional asymmetry index increase confined to the bilateral caudate. Individuals with progressive supranuclear palsy exhibited a distinct regional asymmetry index increase in the pallido-subthalamic pathway. Notably, the regional asymmetry index increase in the subthalamic nucleus was significantly greater in progressive supranuclear palsy than in Parkinson's disease.

Conclusion: The current study revealed distinctive regional asymmetry in dopaminergic and serotoninergic dysfunction in degenerative parkinsonisms. The present findings highlight the potential application of visual diagnosis in degenerative parkinsonisms.
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http://dx.doi.org/10.1016/j.jns.2021.117363DOI Listing
April 2021

Harmonized pretreatment quantitative volume-based FDG-PET/CT parameters for prognosis of stage I-III breast cancer: Multicenter study.

Oncotarget 2021 Jan 19;12(2):95-105. Epub 2021 Jan 19.

Department of Radiology, Hyogo College of Medicine, Hyogo, Japan.

Objectives: This study investigated harmonized pretreatment volume-based quantitative FDG-PET/CT parameters in breast cancer patients for prognostic value.

Results: During a median overall follow-up period of 5.3 years, 91 patients had recurrence and 40 died. Multivariate analysis of ER-positive/HER2-negative patients showed high maximum standardized uptake value (SUVmax) ( = 0.018), high total lesion glycolysis (TLG) ( = 0.010), and clinical N-classification ( = 0.0027) as independent negative predictors of RFS, while high maximum SUVmax ( = 0.037), advanced clinical T-classification ( = 0.030), and advanced TNM stage ( = 0.0067) were independent negative predictors of OS. For recurrence and death in HER2-positive patients, high total TLG ( = 0.037, = 0.0048, respectively) and advanced TNM stage ( = 0.048, = 0.046, respectively) were independent prediction factors. In the triple-negative group, independent factors related to recurrence and death were high maximum SUVmax ( = 0.0014, = 0.0003, respectively) and advanced TNM stage ( < 0.0001, < 0.0001, respectively).

Materials And Methods: Records of 546 stage I-III invasive breast cancer patients, including 344 estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, 110 HER2-positive, and 92 triple-negative cases, treated at four institutions were reviewed retrospectively. Harmonized primary tumor and nodal maximum SUVmax, metabolic tumor volume (MTV), and TLG indicated in pretreatment FDG-PET/CT results were analyzed. Evaluations of relationships of clinicopathological factors, volume-based quantitative parameters, recurrence-free survival (RFS), and overall survival (OS) for each subtype were performed with a Cox proportional hazards model and log-rank test.

Conclusions: The results indicated that potential surrogate markers for prognosis in patients with the three main subtypes of operable breast cancer include harmonized pretreatment quantitative volume-based FDG-PET/CT parameters, particularly whole-lesion SUVmax and TLG.
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http://dx.doi.org/10.18632/oncotarget.27851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825640PMC
January 2021

Quantitative Evaluation of F-Flutemetamol PET in Patients With Cognitive Impairment and Suspected Alzheimer's Disease: A Multicenter Study.

Front Neurol 2020 13;11:578753. Epub 2021 Jan 13.

Department of Radiology, National Center of Neurology and Psychiatry, Kodaira, Japan.

In clinical practice, equivocal findings are inevitable in visual interpretation of whether amyloid positron emission tomography (PET) is positive or negative. It is therefore necessary to establish a more objective quantitative evaluation method for determining the indication for disease-modifying drugs currently under development. We aimed to determine cutoffs for positivity in quantitative analysis of F-flutemetamol PET in patients with cognitive impairment and suspected Alzheimer's disease (AD). We also evaluated the clinical efficacy of amyloid PET in the diagnosis of AD. This study was registered in the Japan Registry of Clinical Trials (jRCTs, 031180321). Ninety-three patients suspected of having AD underwent F-flutemetamol PET in seven institutions. A PET image for each patient was visually assessed and dichotomously rated as either amyloid-positive or amyloid-negative by two board-certified nuclear medicine physicians. If the two readers obtained different interpretations, the visual rating was rerun until they reached consensus. The PET images were quantitatively analyzed using the standardized uptake value ratio (SUVR) and standardized Centiloid (CL) scale with the whole cerebellum as a reference area. Visual interpretation obtained 61 positive and 32 negative PET scans. Receiver operating characteristic analysis determined the best agreement of quantitative assessments and visual interpretation of PET scans to have an area under curve of 0.982 at an SUVR of 1.13 and a CL of 16. Using these cutoff values, there was high agreement between the two approaches (kappa = 0.88). Five discordant cases had SUVR and CL values ranging from 1.00 to 1.22 and from 1 to 26, respectively. In these discordant cases, either diffuse or mildly focal elevation of cortical activity confused visual interpretation. The amyloid PET outcome significantly altered the diagnosis of AD (χ = 51.3, < 0.0001). PET imaging elevated the proportions of the very high likelihood category from 20.4 to 46.2% and the very low likelihood category from 0 to 22.6%. Quantitative analysis of amyloid PET using F-flutemetamol can objectively evaluate amyloid positivity using the determined cutoffs for SUVR and CL. Moreover, amyloid PET may have added value over the standard diagnostic workup in dementia patients with cognitive impairment and suspected AD.
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http://dx.doi.org/10.3389/fneur.2020.578753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838486PMC
January 2021

Dual-Energy Computed Tomography of the Liver: Uses in Clinical Practices and Applications.

Diagnostics (Basel) 2021 Jan 22;11(2). Epub 2021 Jan 22.

Department of Gastroenterology and Hepatology, Kindai University, Faculty of Medicine, Osakasayama 589-8511, Japan.

Dual-energy computed tomography (DECT) is an imaging technique based on data acquisition at two different energy settings. Recent advances in CT have allowed data acquisitions and simultaneous analyses of X-rays at two energy levels, and have resulted in novel developments in the field of abdominal imaging. The use of low and high X-ray tube voltages in DECT provide fused images that improve the detection of liver tumors owing to the higher contrast-to-noise ratio (CNR) of the tumor compared with the liver. The use of contrast agents in CT scanning improves image quality by enhancing the CNR and signal-to-noise ratio while reducing beam-hardening artifacts. DECT can improve detection and characterization of hepatic abnormalities, including mass lesions. The technique can also be used for the diagnosis of steatosis and iron overload. This article reviews and illustrates the different applications of DECT in liver imaging.
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http://dx.doi.org/10.3390/diagnostics11020161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912647PMC
January 2021

Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus (Third Edition): Endorsed by the Japanese Society of Normal Pressure Hydrocephalus.

Neurol Med Chir (Tokyo) 2021 Feb 15;61(2):63-97. Epub 2021 Jan 15.

Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan.

Among the various disorders that manifest with gait disturbance, cognitive impairment, and urinary incontinence in the elderly population, idiopathic normal pressure hydrocephalus (iNPH) is becoming of great importance. The first edition of these guidelines for management of iNPH was published in 2004, and the second edition in 2012, to provide a series of timely, evidence-based recommendations related to iNPH. Since the last edition, clinical awareness of iNPH has risen dramatically, and clinical and basic research efforts on iNPH have increased significantly. This third edition of the guidelines was made to share these ideas with the international community and to promote international research on iNPH. The revision of the guidelines was undertaken by a multidisciplinary expert working group of the Japanese Society of Normal Pressure Hydrocephalus in conjunction with the Japanese Ministry of Health, Labour and Welfare research project. This revision proposes a new classification for NPH. The category of iNPH is clearly distinguished from NPH with congenital/developmental and acquired etiologies. Additionally, the essential role of disproportionately enlarged subarachnoid-space hydrocephalus (DESH) in the imaging diagnosis and decision for further management of iNPH is discussed in this edition. We created an algorithm for diagnosis and decision for shunt management. Diagnosis by biomarkers that distinguish prognosis has been also initiated. Therefore, diagnosis and treatment of iNPH have entered a new phase. We hope that this third edition of the guidelines will help patients, their families, and healthcare professionals involved in treating iNPH.
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http://dx.doi.org/10.2176/nmc.st.2020-0292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905302PMC
February 2021

The effect of breast density on the missed lesion rate in screening digital mammography determined using an adjustable-density breast phantom tailored to Japanese women.

PLoS One 2021 7;16(1):e0245060. Epub 2021 Jan 7.

Graduate School of Health Sciences, Niigata University, Niigata, Japan.

Objective: Despite the high risk of missing lesions in mammography, the missed lesion rate is yet to be clinically established. Further, no breast phantoms with adjustable breast density currently exist. We developed a novel, adjustable-density breast phantom with a composition identical to that of actual breasts, and determined the quantitative relationship between breast density and the missed lesion rate in mammography.

Methods: An original breast phantom consisting of adipose- and fibroglandular-equivalent materials was developed, and a receiver operating characteristic (ROC) study was performed. Breast density, which is the fraction by weight of fibroglandular to total tissue, was adjusted to 25%, 50%, and 75% by arbitrarily mixing the two materials. Microcalcification, mass lesions, and spiculated lesions, each with unique characteristics, were inserted into the phantom. For the above-mentioned fibroglandular densities, 50 positive and 50 negative images for each lesion type were used as case samples for the ROC study. Five certified radiological technologists participated in lesion detection.

Results: The mass-lesion detection rate, according to the area under the curve, decreased by 18.0% (p = 0.0001, 95% Confidence intervals [CI] = 0.1258 to 0.1822) and 37.8% (p = 0.0003, 95% CI = 0.2453 to 0.4031) for breast densities of 50% and 75%, respectively, compared to that for a 25% breast density. A similar tendency was observed with microcalcification; however, spiculated lesions did not follow this tendency.

Conclusions: We quantified the missed lesion rate in different densities of breast tissue using a novel breast phantom, which is imperative for advancing individualized screening mammography.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245060PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790234PMC
January 2021

Predictive factors of truncation artifacts in the arterial phase of Gd-EOB-DTPA-enhanced MRI: a nationwide multicenter study.

Jpn J Radiol 2021 Feb 6;39(2):165-177. Epub 2020 Oct 6.

Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.

Purpose: To identify predictive factors for truncation artifacts (TAs) in the arterial phase of Gd-EOB-DTPA-enhanced MRI in a multicenter study in Japan.

Materials And Methods: Data on patient factors (age, sex, weight, presence of viral hepatitis, and other conditions) and imaging parameters (e.g., triggering, voxel size, matrix, k-space ordering, acquisition time, reduction factor, flip angle, fat suppression, field strength, injection rate, and saline volume) were obtained. Univariate and multivariate analyses were performed to investigate the correlation of these parameters.

Results: We evaluated 1444 patients from 43 institutions who were scanned using GE, Siemens, Philips, or Toshiba MRI equipment (501, 354, 349, and 240 patients, respectively). The total incidence of TAs was 12.5% (17.2, 3.6, 15.7, and 12.1%, respectively). The matrix [odds ratio (OR) 0.13], flip angle (OR 5.77), use of fat suppression (OR 0.106), and field strength (OR 0.092) used in the Philips equipment significantly increased the incidence of TAs in MRI examination.

Conclusions: The incidence of TAs in the arterial phase is influenced by several patient factors and imaging parameters. Especially, Siemens and Toshiba equipment had a significantly lower frequency of TAs. This indicates that such vendor-specific technology used in the dynamic sequence may have a TA-resistant effect.
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http://dx.doi.org/10.1007/s11604-020-01052-xDOI Listing
February 2021

Diagnostic utility of fusion F-fluorodeoxyglucose positron emission tomography/cardiac magnetic resonance imaging in cardiac sarcoidosis.

J Nucl Cardiol 2020 Oct 1. Epub 2020 Oct 1.

Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan.

Background: Although each F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) has been used to diagnose cardiac sarcoidosis (CS), active CS is still misdiagnosed.

Methods: Active CS, diagnosed by PET alone, was defined as focal or focal on diffuse FDG uptake pattern. In fusion PET/CMR imaging, using a regional analysis with AHA 17-segment model, the patients were categorized into four groups: (1) PET-/LGE-, (2) PET+/LGE-, (3) PET+/LGE+, and (4) PET-/LGE+. PET+/LGE+ was defined as active CS.

Results: 74 Patients with suspected CS were enrolled. Between PET alone and fusion PET/CMR imaging, 20 cases had mismatch evaluations of active CS, and most had diffuse or focal on diffuse FDG uptake pattern on PET alone imaging. 40 Patients fulfilled the 2016 the Japanese Circulation Society diagnostic criteria for CS. The interobserver diagnostic agreement was excellent (κ statistics 0.89) and the overall accuracy for diagnosing CS was 87.8% in fusion PET/CMR imaging, which were superior to those in PET alone imaging (0.57 and 82.4%, respectively). In a sub-analysis of diffuse and focal on diffuse patterns, the agreement (κ statistics 0.86) and overall accuracy (81.8%) in fusion PET/CMR imaging were still better.

Conclusions: Fusion PET/CMR imaging with regional analysis offered reliable and accurate diagnosis of CS, covering low diagnostic area by FDG-PET alone.
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http://dx.doi.org/10.1007/s12350-020-02359-yDOI Listing
October 2020

Transcatheter Arterial Embolization Treatment for Bleeding Visceral Artery Pseudoaneurysms in Patients with Pancreatitis or Following Pancreatic Surgery.

Cancers (Basel) 2020 Sep 23;12(10). Epub 2020 Sep 23.

Department of Diagnostic Radiology, Kobe University, Graduate School of Medicine. 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo 650-0017, Japan.

Purpose: To evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for pseudoaneurysms occurring secondary to pancreatitis or because of leakage of pancreatic juice after pancreatectomy.

Materials And Methods: This retrospective study included 42 consecutive patients (38 males and 4 females; mean age, 60 years; range, 33-80 years) who underwent TAE for bleeding visceral artery pseudoaneurysms between March 2004 and December 2018. The technical and clinical success rates, incidence of recurrent bleeding, complications, including pancreatitis, and overall survival after TAE were evaluated.

Results: Of the 42 enrolled patients, 23 had bleeding due to a complication of pancreatectomy and 19 had bleeding as a complication of pancreatitis. TAE with N-butyl cyanoacrylate (NBCA) or NBCA plus microcoils recurrent bleeding or inability to control bleeding was 15.8% (3 of 19) following TAE with NBCA and 17.4% (4 of 23) following TAE with coils. No clinically significant ischemic events of the pancreas or duodenum were observed in the embolized areas. Serum amylase did not increase compared with the initial levels after any of the procedures. At 30 days after TAE, 32 patients were alive.

Conclusion: TAE has a high success rate for the management of hemorrhage, with few complications. The procedure appears to be safe and effective for pseudoaneurysms associated with either pancreatitis or pancreatectomy.
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http://dx.doi.org/10.3390/cancers12102733DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598255PMC
September 2020

Magnetic Resonance Imaging of Recurrent Adult Granulosa Cell Tumor of the Ovary: A Retrospective Analysis of 11 Cases.

J Comput Assist Tomogr 2020 Nov/Dec;44(6):887-892

Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan.

Objective: The aim of the study was to characterize magnetic resonance imaging findings in patients with recurrent ovarian adult granulosa cell tumors (AGCTs).

Methods: Clinical and magnetic resonance imaging manifestations of recurrent AGCTs were evaluated in 11 patients.

Results: Initial recurrences of AGCT were diagnosed between 13 months and 30 years (mean, 11.3 years). Recurrent tumors were located in the pelvic peritoneum, the abdominal peritoneum, the retroperitoneum, and bone. The number of recurrent tumors varied from 1 to 5. Tumors varied in morphology and all margins were well circumscribed. The internal structures noted were as follows: multilocular cystic and solid and cystic. Furthermore, internal hemorrhage and sponge-like multicystic components were identified.

Conclusions: Ovarian AGCTs recurred in the pelvic peritoneum, abdominal peritoneum, and the retroperitoneal lymph nodes. Large recurrent AGCTs were commonly well circumscribed, round or lobulated, and multilocular cystic or solid and cystic. Moreover, they frequently included internal hemorrhage and sponge-like multicystic components.
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http://dx.doi.org/10.1097/RCT.0000000000001096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7668338PMC
December 2020

Spontaneous closure of non-cavernous sinus dural arteriovenous fistulas: A case series and systematic review of the literature.

J Neuroradiol 2020 Sep 9. Epub 2020 Sep 9.

Department of Radiology, Osaka University Graduate School of Medicine, Japan. Electronic address:

Background And Purpose: To report 9 new cases of non-cavernous sinus dural arteriovenous fistulas (NCS-DAVFs) that closed spontaneously and systematically review reports of other cases in the literature.

Material And Methods: We performed a retrospective analysis of 9 cases from 2 institutions of NCS-DAVFs that closed spontaneously. Using PubMed and Scopus in accordance with the PRISMA guidelines, we systematically reviewed English language articles about NCS-DAVFs showing spontaneous closure.

Results: Review of the cases from 2 institutions identified 9 cases of NCS-DAVFs showing spontaneous closure in follow-up magnetic resonance angiography (MRA), and the systematic review of the literature yielded an additional 38 cases, which had been diagnosed by repeated arteriography. Collectively, the patients included 23 men and 24 women with a mean age of 54 years. The shunts were located in the transverse-sigmoid sinus in 24 cases (51%), anterior condylar confluence in 11, and other locations in 12. Based on the venous drainage pattern on arteriography, 27 cases (57%) were classified as low-risk NCS-DAVF (without cortical venous reflux) and 17 were classified as high-risk NCS-DAVF (with cortical venous reflux). Shunt closure was observed within 3 months in 17 cases (36%). Extrinsic predisposing factors for shunt closure were detected in 14 cases (30%). These included angiography in 7 cases, sinus recanalization in 4, development of sinus occlusion in 2, and sinus compression by a newly developed hematoma in 1.

Conclusion: Spontaneous closures of NCS-DAVFs can occur for both high- and low-risk types. One-third of these closures occur within 3 months.
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http://dx.doi.org/10.1016/j.neurad.2020.09.002DOI Listing
September 2020

Progressive amnestic cognitive impairment in a middle-aged patient with developmental language disorder: a case report.

J Med Case Rep 2020 Sep 3;14(1):139. Epub 2020 Sep 3.

Department of Neuropsychiatry, Faculty of Medicine, Kindai University, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan.

Background: Developmental disorder and dementia in older adults have been considered unrelated clinical entities because their timing of diagnosis differs greatly; however, recent studies have suggested an association between them. This case describes a middle-aged patient with language disorder exhibiting progressive amnestic cognitive impairment.

Case Presentation: A 44-year-old Japanese man with long-term language dysfunction presented for his first-ever medical evaluation at age 36 years. Although his conversational ability had been impaired since childhood, he was able to graduate from secondary school and gain unskilled employment. At age 36 years, however, his workplace environment became more stressful, which led to behavioral problems that necessitated medical consultation. He consulted two psychiatrists in vain. At age 44 years, the third attending psychiatrist examined him in detail. The major component of his language disorder was amnestic cognitive impairment in the language domain as shown by logical memory subtests of the Wechsler Memory Scale-Revised. Magnetic resonance imaging showed normal findings for his age and no small vessel disease. Global cerebral hypoperfusion versus cerebellar blood flow was shown on (I) iodoamphetamine single-photon emission computed tomography, and amyloid-β deposition was negative on positron emission tomography with C-Pittsburgh compound B. Pathologic tau accumulation was negative on F-THK5351 positron emission tomography imaging. Laboratory tests show no infections, no vitamin deficiencies, and no other diseases that may cause dementia. Clinical features, results of neurocognitive tests and neuroimaging studies showed no well-known neurodegenerative diseases. Collectively, he was diagnosed with language disorder based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Over a 2-year follow-up period, amnestic cognitive impairment in visual and language domains progressed in parallel with global cerebral hypoperfusion.

Conclusion: This case suggests a possible link between language disorder as defined by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria and progressive amnestic cognitive impairment in middle age, which may ultimately lead to dementia, derived from a neurodegenerative disease.
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http://dx.doi.org/10.1186/s13256-020-02483-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469298PMC
September 2020

Regional gray matter-dedicated SUVR with 3D-MRI detects positive amyloid deposits in equivocal amyloid PET images.

Ann Nucl Med 2020 Nov 27;34(11):856-863. Epub 2020 Aug 27.

Graduate School of Biology-Oriented Science and Technology, Kindai University, 930 Nishimitani, Kinokawa City, Wakayama, 649-6493, Japan.

Purpose: It is usually easy to judge whether amyloid PET images should be interpreted as positive or negative for amyloid deposits by visual inspection or quantitative measurement standard uptake value ratio (SUVR), but the findings are equivocal in some cases. As conventional mean cortical SUVR (mcSUVR) measures accumulation in both gray matter (GM) and white matter, it may mis-estimate amyloid deposits. The purpose of the study was to develop a regional GM-dedicated SUVR measuring (GMSUVR) system for amyloid PET images with 3D-MRI, and evaluate its utility for detecting amyloid deposits in equivocal cases.

Methods: Of 126 subjects who underwent amyloid PET with C-PiB and 3D-MRI, the area of amyloid-positive regions and the critical regional GMSUVR thresholds were first determined in 15 amyloid-positive and 15 amyloid-negative patients, using the automatic volumetric measurement of segmented brain images system. We then tested 36 amyloid-negative, 60 amyloid-positive, and 13 equivocal subjects with this GMSUVR system and with conventional mcSUVR.

Results: Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were 100%, 92%, 97%, 95%, and 100% for the GMSUVR system; and 97%, 86%, 93%, 92% and 94%, respectively, for mcSUVR. In 24 cases in which the findings were equivocal or discordant, the sensitivity, specificity, accuracy, PPV, and NPV were all 100% for the GMSUVR system; and were 90%, 33%, 83%, 90%, and 33%, respectively, for mcSUVR.

Conclusion: The regional GMSUVR measurement method was well able to discriminate between amyloid-positive and -negative subjects, even in cases where amyloid deposition was equivocal.
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http://dx.doi.org/10.1007/s12149-020-01513-3DOI Listing
November 2020

Association between the Onset of Idiopathic Normal Pressure Hydrocephalus Symptoms and Reduced Default Mode Network Connectivity.

Dement Geriatr Cogn Disord 2020 19;49(3):255-263. Epub 2020 Aug 19.

Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Japan.

Objective: The aim was to examine the association between connectivity changes in the default mode network (DMN) and the progression of idiopathic normal pressure hydrocephalus (iNPH).

Methods: We retrospectively recruited cases of preclinical and clinical iNPH from 2,196 patients who had received whole-body 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scanning. We included 31 cases with asymptomatic ventriculomegaly with features of iNPH on MRI (AVIM; reported as preclinical iNPH) and 12 with iNPH. We performed a voxel-based analysis of the brain FDG-PET images of the AVIM and iNPH groups as well as for each background-matched normal control (NC) group, using Statistical Parametric Mapping 12. Volume of interest (VOI)-based analysis was also performed. We set the VOI as the region from the precuneus to the posterior cingulate cortices (PCC), and compared the mean regional standardized uptake value ratio (SUVR) between the AVIM and iNPH group FDG-PET/CT images and each corresponding NC group.

Results: The voxel-based analysis showed a greater decreased FDG uptake in the PCC in the iNPH group than in the AVIM group. The VOI-based analysis revealed no significant difference in the mean SUVR of the AVIM group and the corresponding NC group, but that of the iNPH group was significantly lower than that of its corresponding NC group.

Conclusions: DMN connectivity was reduced in the clinical iNPH group but not in the preclinical group. These data suggest that alterations in the functional connectivity of the DMN are related to the onset of iNPH symptoms.
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http://dx.doi.org/10.1159/000508338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7949227PMC
August 2020

Image quality comparison of a nonlinear image-based noise reduction technique with a hybrid-type iterative reconstruction for pediatric computed tomography.

Phys Med 2020 Aug 6;76:100-108. Epub 2020 Jul 6.

Department of Radiology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511, Japan. Electronic address:

Purpose: To compare computed tomography (CT) image properties between a vendor-independent image-based noise reduction technique, Image-space Noise Reduction (iNoir) and a hybrid-type iterative reconstruction technique, Adaptive Statistical Iterative Reconstruction (ASIR).

Methods: A cylindrical water phantom, corresponding to pediatric body size, containing soft-tissue-equivalent rod and 12-mg iodine/ml rod was scanned at size-specific dose estimates of 8.4 and 16.7 mGy. For assessments of image quality and noise texture change, task-based system performance function (SPF) and peak frequency difference (PFD) were compared, respectively, among filtered back projection (FBP), IR image with 50%-blending rate (50%ASIR), 100%ASIR, 50%iNoir, and 100%iNoir. Human observer test for pediatric CT images was performed by radiologists.

Results: For the soft-tissue contrast, SPF of 100%iNoir was the highest. The average SPF between 0.1 and 0.5 cycles/mm for 100%iNoir increased by approximately 70% compared with FBP, while ASIR indicted slight increases in the frequency region of >0.2 cycles/mm. For the iodine contrast, 100%iNoir indicated highest values at the spatial frequencies corresponding pediatric artery diameters. The PFDs of iNoir were negligible and lower than that of ASIR. The results of human observer test supported results of SPF and PFD.

Conclusions: Compared with ASIR, iNoir provided better image quality for pediatric abdominal CT without compromising noise texture change.
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http://dx.doi.org/10.1016/j.ejmp.2020.06.015DOI Listing
August 2020

Efficiency of a computer-aided diagnosis (CAD) system with deep learning in detection of pulmonary nodules on 1-mm-thick images of computed tomography.

Jpn J Radiol 2020 Nov 26;38(11):1052-1061. Epub 2020 Jun 26.

Department of Radiology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.

Purpose: To evaluate the performance of a deep learning-based computer-aided diagnosis (CAD) system at detecting pulmonary nodules on CT by comparing radiologists' readings with and without CAD.

Materials And Methods: A total of 120 chest CT images were randomly selected from patients with suspected lung cancer. The gold standard of nodules ≥ 3 mm was established by a panel of three expert radiologists. Two less experienced radiologists read the images without and afterward with CAD system. Their reading times were recorded.

Results: The radiologists' sensitivity increased from 20.9% to 38.0% with the introduction of CAD. The positive predictive value (PPV) decreased from 70.5% to 61.8%, and the F1-score increased from 32.2% to 47.0%. The sensitivity significantly increased from 13.7% to 32.4% for small nodules (3-6 mm) and from 33.3% to 47.6% for medium nodules (6-10 mm). CAD alone showed a sensitivity of 70.3%, a PPV of 57.9%, and an F1-score of 63.5%. Reading time decreased by 11.3% with the use of CAD.

Conclusion: CAD improved the less experienced radiologists' sensitivity in detecting pulmonary nodules of all sizes, especially including a significant improvement in the detection of clinically important-sized medium nodules (6-10 mm) as well as small nodules (3-6 mm) and reduced their reading time.
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http://dx.doi.org/10.1007/s11604-020-01009-0DOI Listing
November 2020

Assessment of Liver Metastases Using CT and MRI Scans in Patients with Pancreatic Ductal Adenocarcinoma: Effects of Observer Experience on Diagnostic Accuracy.

Cancers (Basel) 2020 Jun 3;12(6). Epub 2020 Jun 3.

Department of Radiology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan.

The aim of this study was to investigate the impact of radiologic experience on the diagnostic accuracy of computed tomography (CT) vs. magnetic resonance imaging (MRI) reporting on the liver metastases of pancreatic ductal adenocarcinoma (LM of PDAC). Intra-individual CT and MRI examinations of 112 patients with clinically proven LM of PDAC were included. Four radiologists with varying years of experience (A > 20, B > 5, C > 1 and D < 1) assessed liver segments affected by LM of PDAC, as well as associated metastases occurring in each patient. Their sensitivity and specificity in evaluating the segments were compared. Cohen's Kappa (κ) for diagnosed liver segments and Intra-class Correlation Coefficients (ICC) for the number of metastatic lesions in each patient were calculated. The radiologists' sensitivity and specificity for the CT vs. MRI were, respectively: Reader A-94.4%, 90.3% vs. 96.6%, 94.8%; B-86.7%, 79.7% vs. 83.9%, 82.0%; C-78.0%, 76.7% vs. 83.3%, 78.9% and D-71.8%, 79.2% vs. 64.0%, 69.5%. Reviewers A and B achieved greater agreement in assessing results from the MRI (κ = 0.72, < 0.001; ICC = 0.73, < 0.001) vs. the CT (κ = 0.58, < 0.001; ICC = 0.61, < 0.001), in contrast to readers C and D (MRI: κ = 0.34, < 0.001; ICC = 0.42, < 0.001, and CT: κ = 0.48, < 0.001; ICC = 0.59, < 0.001). Our results indicate that the accurate diagnosis of LM of PDAC depends more on radiologic experience in MRI over CT scans.
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http://dx.doi.org/10.3390/cancers12061455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352533PMC
June 2020

AI approach of cycle-consistent generative adversarial networks to synthesize PET images to train computer-aided diagnosis algorithm for dementia.

Ann Nucl Med 2020 Jul 20;34(7):512-515. Epub 2020 Apr 20.

Division of Positron Emission Tomography, Institute of Advanced Clinical Medicine, Kindai University, Osaka, Japan.

Objective: An artificial intelligence (AI)-based algorithm typically requires a considerable amount of training data; however, few training images are available for dementia with Lewy bodies and frontotemporal lobar degeneration. Therefore, this study aims to present the potential of cycle-consistent generative adversarial networks (CycleGAN) to obtain enough number of training images for AI-based computer-aided diagnosis (CAD) algorithms for diagnosing dementia.

Methods: We trained CycleGAN using 43 amyloid-negative and 45 positive images in slice-by-slice.

Results: The CycleGAN can be used to synthesize reasonable amyloid-positive images, and the continuity of slices was preserved.

Discussion: Our results show that CycleGAN has the potential to generate a sufficient number of training images for CAD of dementia.
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http://dx.doi.org/10.1007/s12149-020-01468-5DOI Listing
July 2020

18F-FDG PET/CT Finding of Primary Cardiac Lymphoma.

Clin Nucl Med 2020 Apr;45(4):319-321

From the Departments of Radiology.

An 80-year-old woman experienced dyspnea. Cardiac enlargement was detected by chest radiography at a local hospital. She was admitted to our hospital, and echocardiography and CT revealed pericardial effusion and multiple tumor lesions in right atrium. F-FDG PET/CT demonstrated multiple nodular accumulations in these tumors (SUVmax, 14.5). Cytologic analysis of the pericardial fluid revealed a diffuse large B-cell lymphoma. Primary cardiac lymphoma (PCL) is rare, and there are few reports about the F-FDG PET/CT imaging features of PCLs. In high F-FDG uptake in multiple tumors in the right atrium and large pericardial effusion, a PCL should be considered.
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http://dx.doi.org/10.1097/RLU.0000000000002957DOI Listing
April 2020

A strategy to account for noise in the X-variable to reduce underestimation in Logan graphical analysis for quantifying receptor density in positron emission tomography.

BMC Med Imaging 2020 02 10;20(1):15. Epub 2020 Feb 10.

Department of Electrical Engineering and Electronics, Graduate School of Engineering, Kogakuin University, Shinjuku, Tokyo, Japan.

Background: The Logan graphical analysis (LGA) algorithm is widely used to quantify receptor density for parametric imaging in positron emission tomography (PET). Estimating receptor density, in terms of the non-displaceable binding potential (BP), from the LGA using the ordinary least-squares (OLS) method has been found to be negatively biased owing to noise in PET data. This is because OLS does not consider errors in the X-variable (predictor variable). Existing bias reduction methods can either only reduce the bias slightly or reduce the bias accompanied by increased variation in the estimates. In this study, we addressed the bias reduction problem by applying a different regression method.

Methods: We employed least-squares cubic (LSC) linear regression, which accounts for errors in both variables as well as the correlation of these errors. Noise-free PET data were simulated, for C-carfentanil kinetics, with known BP values. Statistical noise was added to these data and the BPs were re-estimated from the noisy data by three methods, conventional LGA, multilinear reference tissue model 2 (MRTM2), and LSC-based LGA; the results were compared. The three methods were also compared in terms of beta amyloid (A β) quantification of C-Pittsburgh compound B brain PET data for two patients with Alzheimer's disease and differing A β depositions.

Results: Amongst the three methods, for both synthetic and actual data, LSC was the least biased, followed by MRTM2, and then the conventional LGA, which was the most biased. Variations in the LSC estimates were smaller than those in the MRTM2 estimates. LSC also required a shorter computational time than MRTM2.

Conclusions: The results suggest that LSC provides a better trade-off between the bias and variability than the other two methods. In particular, LSC performed better than MRTM2 in all aspects; bias, variability, and computational time. This makes LSC a promising method for BP parametric imaging in PET studies.
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http://dx.doi.org/10.1186/s12880-020-0421-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011280PMC
February 2020

infection-induced endoplasmic reticulum stress causes fatty acid-binding protein 4 secretion in murine adipocytes.

J Biol Chem 2020 02 28;295(9):2713-2723. Epub 2020 Jan 28.

Department of Microbiology & Immunology, Fukuoka University Faculty of Medicine, Fukuoka 814-0180, Japan. Electronic address:

Fatty acid-binding protein 4 (FABP4) is predominantly expressed in adipocytes and macrophages and regulates metabolic and inflammatory pathways. FABP4 is secreted from adipocytes during lipolysis, and elevated circulating FABP4 levels are associated with obesity, metabolic disease, and cardiac dysfunction. We previously reported that the bacterial respiratory pathogen infects murine adipocytes and exploits host FABP4 to mobilize fat and replicate within adipocytes. However, whether induces FABP4 secretion from adipocytes has not been determined. Here, we show that FABP4 is actively secreted by murine adipocytes upon infection. Chemical inhibition of lipase activity and genetic deficiency of hormone-sensitive lipase blocked FABP4 secretion from -infected adipocytes. Mechanistically, infection induced endoplasmic reticulum (ER) stress and the unfolded protein response (UPR), resulting in elevated levels of mitochondrial reactive oxygen species and cytosolic Ca Of note, exposure to a mitochondrial reactive oxygen species-specific scavenger, MitoTEMPO, reduced FABP4 release from -infected adipocytes. Furthermore, treatment with azoramide, which protects cells against ER stress, decreased FABP4 release from -infected adipocytes. Using gene silencing of CHOP (C/EBP homologous protein), a central regulator of ER stress, we further validated the role of infection-induced ER stress/UPR in promoting FABP4 secretion. Overall, these results indicate that infection robustly induces FABP4 secretion from adipocytes by stimulating ER stress/UPR. Our findings shed additional light on the etiological link between infection and metabolic syndrome.
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http://dx.doi.org/10.1074/jbc.RA119.010683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7049972PMC
February 2020

Improved Risk Stratification for Progression from Mild Cognitive Impairment to Alzheimer's Disease with a Multi-Analytical Evaluation of Amyloid-β Positron Emission Tomography.

J Alzheimers Dis 2020 ;74(1):101-112

Department of Nuclear Medicine, Inselspital, University Hospital Bern, Bern, Switzerland.

Background: Amyloid-β (Aβ) accumulation in brain of patients with suspected Alzheimer's disease (AD) can be assessed by positron emission tomography (PET) in vivo. While visual classification prevails in the clinical routine, semiquantitative PET analyses may enable more reliable evaluation of cases with a visually uncertain, borderline Aβ accumulation.

Objective: We evaluated different analysis approaches (visual/semiquantitative) to find the most accurate and sensitive interpretation of Aβ-PET for predicting risk of progression from mild cognitive impairment (MCI) to AD.

Methods: Based on standard uptake value (SUV) ratios of a cortical-composite volume of interest of 18F-AV45-PET from MCI subjects (n = 396, ADNI database), we compared three different reference region (cerebellar grey matter, CBL; brainstem, BST; white matter, WM) normalizations and the visual read by receiver operator characteristics for calculating a hazard ratio (HR) for progression to Alzheimer's disease dementia (ADD).

Results: During a mean follow-up time of 45.6±13.0 months, 28% of the MCI cases (110/396) converted to ADD. Among the tested methods, the WM reference showed best discriminatory power and progression-risk stratification (HRWM of 4.4 [2.6-7.6]), but the combined results of the visual and semiquantitative analysis with all three reference regions showed an even higher discriminatory power.

Conclusion: A multi-analytical composite of visual and semiquantitative reference tissue analyses of 18F-AV45-PET gave improved risk stratification for progression from MCI to ADD relative to performance of single read-outs. This optimized approach is of special interest for prospective treatment trials, which demand a high accuracy.
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http://dx.doi.org/10.3233/JAD-190818DOI Listing
January 2020

Navigator-triggered and breath-hold 3D MRCP using compressed sensing: image quality and method selection factor assessment.

Abdom Radiol (NY) 2020 10;45(10):3081-3091

Department of Radiology, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan.

Purpose: To examine whether MRCP using a combination of compressed sensing and sensitivity encoding with navigator-triggered and breath-hold techniques (NT C-SENSE and BH C-SENSE, respectively) have comparable image quality to that of navigator-triggered MRCP using only sensitivity encoding (NT SENSE) at 1.5-T.

Methods: Fifty-one participants were enrolled in this prospective study between July and October 2018 and underwent the three 3D MRCP sequences each. The acquisition time and relative duct-to-periductal contrast ratios (RC values) of each bile duct segment were obtained. Visualization of the bile and main pancreatic ducts, background suppression, artifacts, and overall image quality were scored on 5-point scales. Mean and median differences in RC values and qualitative scores of NT C-SENSE and BH C-SENSE relative to NT SENSE were calculated with 95% confidence intervals (CIs).

Results: Acquisition time of NT SENSE, NT C-SENSE, and BH C-SENSE were 348, 143 (mean for both), and 18 s (for all participants), respectively. The RC value of each bile duct segment was inferior, but the lower limits of the 95% CIs of the mean differences were ≥ - 0.10, for both NT C-SENSE and BH C-SENSE. The visualization score of the intrahepatic duct in BH C-SENSE was inferior to that in NT SENSE (lower 95% CI limit, - 1.5). In both NT C-SENSE and BH C-SENSE, the 95% CIs of the median differences in the other qualitative scores were from - 1.0 to 0.0.

Conclusion: NT C-SENSE and BH C-SENSE have comparable image quality to NT SENSE at 1.5-T.
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http://dx.doi.org/10.1007/s00261-020-02403-yDOI Listing
October 2020

The Landscape Montage Technique for diagnosing frontotemporal dementia starting as primary progressive aphasia: a case report.

J Med Case Rep 2020 Jan 9;14(1). Epub 2020 Jan 9.

Department of Neuropsychiatry, Faculty of Medicine, Kindai University, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan.

Background: The Landscape Montage Technique was originally developed by Hisao Nakai, a Japanese psychiatrist, to pursue the possibility and application of a psychotherapeutic approach using drawing for patients with schizophrenia. Drawing was initially adopted to evaluate patients with an impaired ability for verbal expression, particularly for the diagnosis and treatment of patients with schizophrenia. Since its development, the Landscape Montage Technique has been utilized in various clinical settings throughout Japan. This study aimed to evaluate the psychiatric conditions of a patient diagnosed as having primary progressive aphasia using the Landscape Montage Technique at a 3-year follow-up.

Case Presentation: We present the case of a 64-year-old, right-handed Japanese woman initially diagnosed as having logopenic variant primary progressive aphasia or logopenic aphasia. At a 3-year follow-up, logopenic aphasia progressed to behavioral variant frontotemporal dementia or frontotemporal dementia. According to her husband, she began to have speech difficulties approximately 5 years before her first visit. The results of neurocognitive tests suggested mild cognitive impairment or early stages of dementia. Her clinical dementia rating score was 0.5, suggesting a diagnosis of mild cognitive impairment. She had a Raven's Colored Progressive Matrices score of 31 out of 36, which indicated a nonverbal cognitive ability that was greater than the 90th percentile for her age. The Japanese Standard Language Test of Aphasia, which was performed at two points during the follow-up, indicated the possibility for a diagnosis of primary progressive aphasia given the progression of her aphasia. Based on her clinical symptoms and Japanese Standard Language Test of Aphasia results, a diagnosis of logopenic variant primary progressive aphasia was established. Magnetic resonance imaging revealed severe predominant left frontal and anterior temporal atrophy, as well as bilateral parietal atrophy. Amyloid beta deposition was negative. At the 3-year follow-up, logopenic variant primary progressive aphasia had progressed to behavioral variant frontotemporal dementia. However, the Landscape Montage Technique allowed for the diagnosis of behavioral variant frontotemporal dementia only 2 years after baseline.

Conclusions: The present study showed that the Landscape Montage Technique can be useful for diagnosing behavioral variant frontotemporal dementia that starts as logopenic variant primary progressive aphasia at earlier stages.
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http://dx.doi.org/10.1186/s13256-019-2338-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6951018PMC
January 2020

Changes in cerebral glucose metabolism caused by morphologic features of prodromal idiopathic normal pressure hydrocephalus.

EJNMMI Res 2019 Dec 16;9(1):111. Epub 2019 Dec 16.

Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan.

Background: Decreased cerebral glucose metabolism has been reported in idiopathic normal pressure hydrocephalus (iNPH). However, the timing of appearance in the preclinical stage of iNPH remains unknown. Herein, we evaluated the changes in regional cerebral glucose metabolism with respect to the characteristic morphologic features of iNPH.

Methods: We performed a cross-sectional study in > 2000 elderly patients who received a whole body 18F-fluorodeoxyglucose-positron emission tomography/computed tomography scanning and recruited subjects with clinical and preclinical iNPH. We included 12 subjects with iNPH, 32 subjects with asymptomatic ventriculomegaly with features of iNPH on magnetic resonance imaging (AVIM), and 33 subjects with preclinical morphologic features of DESH (PMD). We previously reported that iNPH develops in the order of PMD (asymptomatic subjects with incomplete DESH), AVIM (asymptomatic subjects with DESH), and iNPH (symptomatic subjects with DESH). We measured the median regional standardized uptake value ratio (SUVR) on 18F-fluorodeoxyglucose-positron emission tomography/computed tomography images between the three groups and compared them with background-matched normal controls in the frontal lobes, temporal lobes, medial parietal lobes, striata, and thalami.

Results: In the frontal and temporal lobes, the SUVR distributions of the PMD, AVIM, and PMD groups were significantly lower than for each NC (p < 0.05 for all). In the medial parietal lobes, the SUVR distributions were significantly higher in PMD and AVIM groups (p < 0.05 for all). In the thalami and striata, the SUVR distributions were significantly lower in the iNPH group (p < 0.05 for all).

Conclusions: Changes in brain glucose metabolism in the cortices are observed in preclinical iNPH, while metabolic decline in the basal ganglia is only detected in clinical iNPH.
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http://dx.doi.org/10.1186/s13550-019-0573-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915186PMC
December 2019