Publications by authors named "Keitaro Sofue"

94 Publications

Estimation of pancreatic fibrosis and prediction of postoperative pancreatic fistula using extracellular volume fraction in multiphasic contrast-enhanced CT.

Eur Radiol 2021 Oct 12. Epub 2021 Oct 12.

Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.

Objective: To investigate the diagnostic performance of the extracellular volume (ECV) fraction in multiphasic contrast-enhanced computed tomography (CE-CT) for estimating histologic pancreatic fibrosis and predicting postoperative pancreatic fistula (POPF).

Methods: Eighty-five patients (49 men; mean age, 69 years) who underwent multiphasic CE-CT followed by pancreaticoduodenectomy with pancreaticojejunal anastomosis between January 2012 and December 2018 were retrospectively included. The ECV fraction was calculated from absolute enhancements of the pancreas and aorta between the precontrast and equilibrium-phase images, followed by comparisons among histologic pancreatic fibrosis grades (F0‒F3). The diagnostic performance of the ECV fraction in advanced fibrosis (F2‒F3) was evaluated using receiver operating characteristic curve analysis. Multivariate logistic regression analysis was used to evaluate the associations of the risk of POPF development with patient characteristics, histologic findings, and CT imaging parameters.

Results: The mean ECV fraction of the pancreas was 34.4% ± 9.5, with an excellent intrareader agreement of 0.811 and a moderate positive correlation with pancreatic fibrosis (r = 0.476; p < 0.001). The mean ECV fraction in advanced fibrosis was significantly higher than that in no/mild fibrosis (44.4% ± 10.8 vs. 31.7% ± 6.7; p < 0.001), and the area under the receiver operating characteristic curve for the diagnosis of advanced fibrosis was 0.837. Twenty-two patients (25.9%) developed clinically relevant POPF. Multivariate logistic regression analysis demonstrated that the ECV fraction was a significant predictor of POPF.

Conclusions: The ECV fraction can offer quantitative information for assessing pancreatic fibrosis and POPF after pancreaticojejunal anastomosis.

Key Points: • There was a moderate positive correlation of the extracellular volume (ECV) fraction of the pancreas in contrast-enhanced CT with the histologic grade of pancreatic fibrosis (r = 0.476; p < 0.001). • The ECV fraction was higher in advanced fibrosis (F2‒F3) than in no/mild fibrosis (F0‒F1) (p < 0.001), with an AUC of 0.837 for detecting advanced fibrosis. • The ECV fraction was an independent risk factor for predicting subclinical (odds ratio, 0.81) and clinical (odds ratio, 0.80) postoperative pancreatic fistula.
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http://dx.doi.org/10.1007/s00330-021-08255-4DOI Listing
October 2021

Major and minor complications of the pancreas after transcatheter arterial embolization using n-butyl-2-cyanoacrylate for acute bleeding from pancreatic arteries.

Jpn J Radiol 2021 Oct 6. Epub 2021 Oct 6.

Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan.

Purpose: The purpose is to investigate the major and minor complications of the pancreas after transcatheter arterial embolization (TAE) using n-butyl-2-cyanoacrylate (NBCA) for bleeding from pancreatic arteries.

Materials And Methods: Thirty-three patients who underwent TAE using NBCA for acute bleeding from pancreatic arteries and their parent arteries followed by contrast-enhanced computed tomography (CE-CT) were evaluated retrospectively. Complications and risk factors were assessed using Mann-Whitney U test or Fisher's exact test for the univariate analysis. Patients' characteristic, embolized artery, procedure details, and clinical outcomes were examined as possible risk factors.

Results: TAE was performed successfully in all patients. Minor pancreatic complications occurred in 10 patients (30%), including acute mild pancreatitis (n = 4) and focal lack of pancreatic parenchymal enhancement on CE-CT without pancreatitis (n = 6). No cases of major pancreatic complications, such as moderate/severe pancreatitis, were reported. Embolized artery was the only significant risk factor. The rate of complications per embolized artery were 15% (three out of 20 patients) in the arteries of the pancreatic head and 54% (seven out of 13 patients) in the arteries of pancreatic body and tail (p = 0.025).

Conclusion: TAE using NBCA for acute bleeding from pancreatic arteries is efficacious and safe. Mild pancreatic complications were observed more frequently in case of embolization of the pancreatic body and tail region than the pancreatic head.
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http://dx.doi.org/10.1007/s11604-021-01203-8DOI Listing
October 2021

Diffusion and quantification of diffusion of prostate cancer.

Br J Radiol 2021 Sep 19:20210653. Epub 2021 Sep 19.

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

For assessing a cancer treatment, and for detecting and characterizing cancer, Diffusion-weighted imaging (DWI) is commonly used. The key in DWI's use extracranially has been due to the emergence of of high-gradient amplitude and multichannel coils, parallelimaging, and echo-planar imaging. The benefit has been fewer motion artefacts and high-quality prostate images.Recently, new techniques have been developed to improve the signal-to-noise ratio of DWI with fewer artefacts, allowing an increase in spatial resolution. For apparent diffusion coefficient quantification, non-Gaussian diffusion models have been proposed as additional tools for prostate cancer detection and evaluation of its aggressiveness. More recently, radiomics and machine learning for prostate magnetic resonance imaging have emerged as novel techniques for the non-invasive characterisation of prostate cancer. This review presents recent developments in prostate DWI and discusses its potential use in clinical practice.
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http://dx.doi.org/10.1259/bjr.20210653DOI Listing
September 2021

Diagnosis of Hepatocellular Carcinoma Using Gd-EOB-DTPA MR Imaging.

Magn Reson Med Sci 2021 Aug 21. Epub 2021 Aug 21.

Department of Radiology, Kobe University Graduate School of Medicine.

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA; Gadoxetic acid; Gadoxetate disodium) is a hepatocyte-specific MR contrast agent. It acts as an extracellular contrast agent in the early phase after intravenous injection, and then is taken up by hepatocytes later. Using this contrast agent, we can evaluate the hemodynamics of the liver and liver tumors, and can therefore improve the detection and characterization of hepatocellular carcinoma (HCC). Gd-EOB-DTPA helps in the more accurate detection of hypervascular HCC than by other agents. In addition, Gd-EOB-DTPA can detect hypovascular HCC, which is an early stage of the multi-stage carcinogenesis, with a low signal in the hepatobiliary phase. In addition to tumor detection and characterization, Gd-EOB-DTPA contrast-enhanced MR imaging can be applied for liver function evaluation and prognoses evaluation. Thus, Gd-EOB-DTPA plays an important role in the diagnosis of HCC. However, we have to employ optimal imaging techniques to improve the diagnostic ability. In this review, we aimed to discuss the characteristics of the contrast media, optimal imaging techniques, diagnosis, and applications.
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http://dx.doi.org/10.2463/mrms.rev.2021-0031DOI Listing
August 2021

The feasibility of transcatheter arterial chemoembolization following radiation therapy for hepatocellular carcinoma.

Acta Radiol Open 2021 Jul 4;10(7):20584601211034965. Epub 2021 Aug 4.

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

Background: Technological developments have led to an increased usage of external-body radiotherapy (RT) for the treatment of hepatocellular carcinoma (HCC). Transcatheter arterial chemoembolization (TACE) may be required later in patients treated with RT because of the high recurrence rate and multinodular presentation of HCC. However, despite the risk of liver function impairment, the cumulative liver damage correlated with TACE following a hepatic RT has not been adequately assessed.

Purpose: To evaluate the feasibility of TACE following RT for HCC.

Materials And Methods: Sixty-seven patients with HCC who underwent TACE after RT were retrospectively evaluated between 2012 and 2018. We assessed increases in Child-Turcotte-Pugh (CTP) by ≥2 points at 1 month, the incidence of major complications, survival duration, and short-term mortality within 6 months after TACE. Furthermore, we evaluated the predictive factors for liver function impairment and short-term mortality.

Results: Eight patients experienced a CTP increase ≥2 points at 1 month. There were no cases of liver abscesses or bilomas. Nine patients died within 6 months following TACE. The mean liver dose (MLD) was a significant predictor of liver function impairment at 1 month ( = 0.042). Low liver functional reserve, distant metastasis ( = 0.037), MLD ( = 0.046), TACE type ( = 0.025), and TACE within 3 months following RT ( = 0.007) were significant predictors of short-term mortality.

Conclusions: Despite the feasibility of TACE following RT, clinicians should pay attention to impaired pretreatment liver function, following high dose RT, and the short duration between RT and TACE.
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http://dx.doi.org/10.1177/20584601211034965DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8358533PMC
July 2021

Efficacy of superselective transcatheter arterial embolization for intractable postpartum hemorrhage due to genital tract trauma after vaginal delivery.

Emerg Radiol 2021 Jul 24. Epub 2021 Jul 24.

Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan.

Purpose: To evaluate the efficacy of superselective transcatheter arterial embolization (TAE) for intractable postpartum hemorrhage (PPH) due to genital tract trauma (GTT) after vaginal delivery.

Methods: We evaluated 27 patients who underwent TAE for intractable PPH due to GTT after vaginal delivery at our institution between January 2008 and December 2020. Patients were divided into two groups according to TAE procedure; TAE performed as close as possible to the bleeding point, at least more peripherally than the second branch of the anterior division of the internal iliac artery, was defined as superselective TAE (S-TAE). TAE performed from the proximal segment of the internal iliac artery was defined as proximal TAE (P-TAE). Patient characteristics, pre-procedural contrast-enhanced computed tomography (CE-CT), procedure details, technical/clinical success, and complications were evaluated separately for the S-TAE and P-TAE groups.

Results: The combined technical/clinical success rate was 92%. No major procedure-related complications were seen (mean follow-up: 6.12 ± 3.93 days). The combined technical/clinical success rate of S-TAE was 100% and of P-TAE was 67% (p = 0.04). S-TAE was performed more frequently in patients with pre-procedural CE-CT (p = 0.01) and use of permanent embolic materials (p = 0.003).

Conclusion: S-TAE is safe and effective for intractable PPH due to GTT. Pre-procedural CE-CT may be useful for detecting the culprit artery and be helpful in performing S-TAE.
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http://dx.doi.org/10.1007/s10140-021-01971-wDOI Listing
July 2021

Comparison of prostate imaging reporting and data system v2.1 and 2 in transition and peripheral zones: evaluation of interreader agreement and diagnostic performance in detecting clinically significant prostate cancer.

Br J Radiol 2021 Jul 8:20201434. Epub 2021 Jul 8.

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

Objective: To evaluate the interreader agreement and diagnostic performance of the Prostate Imaging Reporting and Data System (PI-RADS) v. 2.1, in comparison with v. 2.

Methods: Institutional review board approval was obtained for this retrospective study. 77 consecutive patients who underwent a prostate multiparametric magnetic resonance imaging at 3.0 T before radical prostatectomy were included. Four radiologists (two experienced uroradiologists and two inexperienced radiologists) independently scored eight regions [six peripheral zones (PZ) and two transition zones (TZ)] using v. 2.1 and v. 2. Interreader agreement was assessed using κ statistics. To evaluate diagnostic performance for clinically significant prostate cancer (csPC), area under the curve (AUC) was estimated.

Results: 228 regions were pathologically diagnosed as positive for csPC. With a cut-off ≥3, the agreement among all readers was better with v. 2.1 than v. 2 in TZ, PZ, or both zones combined (κ-value: TZ, 0.509 0.414; PZ, 0.686 0.568; both zones combined, 0.644 0.531). With a cut-off ≥4, the agreement among all readers was also better with v. 2.1 than v. 2 in the PZ or both zones combined (κ-value: PZ, 0.761 0.701; both zones combined, 0.756 0.709). For all readers, AUC with v. 2.1 was higher than with v. 2 (TZ, 0.826-0.907 0.788-0.856; PZ, 0.857-0.919 0.853-0.902).

Conclusion: Our study suggests that the PI-RADS v. 2.1 could improve the interreader agreement and might contribute to improved diagnostic performance compared with v. 2.

Advances In Knowledge: PI-RADS v. 2.1 has a potential to improve interreader variability and diagnostic performance among radiologists with different levels of expertise.
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http://dx.doi.org/10.1259/bjr.20201434DOI Listing
July 2021

Deep learning model for predicting gestational age after the first trimester using fetal MRI.

Eur Radiol 2021 Jun 14;31(6):3775-3782. Epub 2021 Apr 14.

Department of Radiology, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.

Objectives: To evaluate a deep learning model for predicting gestational age from fetal brain MRI acquired after the first trimester in comparison to biparietal diameter (BPD).

Materials And Methods: Our Institutional Review Board approved this retrospective study, and a total of 184 T2-weighted MRI acquisitions from 184 fetuses (mean gestational age: 29.4 weeks) who underwent MRI between January 2014 and June 2019 were included. The reference standard gestational age was based on the last menstruation and ultrasonography measurements in the first trimester. The deep learning model was trained with T2-weighted images from 126 training cases and 29 validation cases. The remaining 29 cases were used as test data, with fetal age estimated by both the model and BPD measurement. The relationship between the estimated gestational age and the reference standard was evaluated with Lin's concordance correlation coefficient (ρc) and a Bland-Altman plot. The ρc was assessed with McBride's definition.

Results: The ρc of the model prediction was substantial (ρc = 0.964), but the ρc of the BPD prediction was moderate (ρc = 0.920). Both the model and BPD predictions had greater differences from the reference standard at increasing gestational age. However, the upper limit of the model's prediction (2.45 weeks) was significantly shorter than that of BPD (5.62 weeks).

Conclusions: Deep learning can accurately predict gestational age from fetal brain MR acquired after the first trimester.

Key Points: • The prediction of gestational age using ultrasound is accurate in the first trimester but becomes inaccurate as gestational age increases. • Deep learning can accurately predict gestational age from fetal brain MRI acquired in the second and third trimester. • Prediction of gestational age by deep learning may have benefits for prenatal care in pregnancies that are underserved during the first trimester.
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http://dx.doi.org/10.1007/s00330-021-07915-9DOI Listing
June 2021

Physiological skin FDG uptake: A quantitative and regional distribution assessment using PET/MRI.

PLoS One 2021 26;16(3):e0249304. Epub 2021 Mar 26.

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

Purpose: To retrospectively assess the repeatability of physiological F-18 labeled fluorodeoxyglucose (FDG) uptake in the skin on positron emission tomography/magnetic resonance imaging (PET/MRI) and explore its regional distribution and relationship with sex and age.

Methods: Out of 562 examinations with normal FDG distribution on whole-body PET/MRI, 74 repeated examinations were evaluated to assess the repeatability and regional distribution of physiological skin uptake. Furthermore, 224 examinations were evaluated to compare differences in the uptake due to sex and age. Skin segmentation on PET was performed as body-surface contouring on an MR-based attenuation correction map using an off-line reconstruction software. Bland-Altman plots were created for the repeatability assessment. Kruskal-Wallis test was performed to compare the maximum standardized uptake value (SUVmax) with regional distribution, age, and sex.

Results: The limits of agreement for the difference in SUVmean and SUVmax of the skin were less than 30%. The highest SUVmax was observed in the face (3.09±1.04), followed by the scalp (2.07±0.53). The SUVmax in the face of boys aged 0-9 years and 10-20 years (1.33±0.64 and 2.05±1.00, respectively) and girls aged 0-9 years (0.98±0.38) was significantly lower than that of men aged ≥20 years and girls aged ≥10 years (p<0.001). In women, the SUVmax of the face (2.31±0.71) of ≥70-year-olds was significantly lower than that of 30-39-year-olds (3.83±0.82) (p<0.05).

Conclusion: PET/MRI enabled the quantitative analysis of skin FDG uptake with repeatability. The degree of physiological FDG uptake in the skin was the highest in the face and varied between sexes. Although attention to differences in body habitus between age groups is needed, skin FDG uptake also depended on age.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249304PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997016PMC
October 2021

evaluation of percutaneous carbon dioxide treatment for improving intratumoral hypoxia using F-fluoromisonidazole PET-CT.

Oncol Lett 2021 Mar 14;21(3):207. Epub 2021 Jan 14.

Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan.

Carbon dioxide (CO) treatment is reported to have an antitumor effect owing to the improvement in intratumoral hypoxia. Previous studies were based on histological analysis alone. In the present study, the improvement in intratumoral hypoxia by percutaneous CO treatment was determined using F-fluoromisonidazole positron emission tomography-computed tomography (F-FMISO PET-CT) images. Twelve Japanese nude mice underwent implantation of LM8 tumor cells in the dorsal subcutaneous area 2 weeks before percutaneous CO treatment and F-FMISO PET-CT scans. Immediately after intravenous injection of F-FMISO, CO and room air were administered transcutaneously in the CO-treated group (n=6) and a control group (n=6), respectively; each treatment was performed for 10 minutes. PET-CT was performed 2 h after administration of F-FMISO. F-FMISO tumor uptake was quantitatively evaluated using the maximum standardized uptake value (SUV), tumor-to-liver ratio (TLR), tumor-to-muscle ratio (TMR), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Mean ± standard error of the mean (SEM) of the tumor volume was not significantly different between the two groups (CO-treated group, 1.178±0.450 cm; control group, 1.368±0.295 cm3; P=0.485). Mean ± SEM of SUV, TLR, MTV (cm3) and TLG were significantly lower in the CO-treated group compared with the control group (0.880±0.095 vs. 1.253±0.071, P=0.015; 1.063±0.147361 vs. 1.455±0.078, P=0.041; 0.353±0.139 vs. 1.569±0.438, P=0.015; 0.182±0.070 vs. 1.028±0.338, P=0.015), respectively. TMR was not significantly different between the two groups (4.520±0.503 vs. 5.504±0.310; P=0.240). In conclusion, F-FMISO PET revealed that percutaneous CO treatment improved intratumoral hypoxia . This technique enables assessment of the therapeutic effect in CO treatment by imaging, and may contribute to its clinical application.
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http://dx.doi.org/10.3892/ol.2021.12468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816357PMC
March 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

Acute pancreatitis in intraductal papillary mucinous neoplasms correlates with pancreatic volume and epithelial subtypes.

Pancreatology 2021 Jan 20;21(1):138-143. Epub 2020 Nov 20.

Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan.

Background: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is associated with acute pancreatitis (AP) in some cases, however its causes have not been fully elucidated. We investigated the association of the incidence of AP with epithelial subtypes and pancreatic volume in IPMN.

Methods: This retrospective study included 182 consecutive surgically resected IPMN patients between January 2000 and December 2018. The relationship between the incidence of AP and epithelial subtypes of IPMN and pancreatic volume was investigated. Epithelial subtypes of IPMN were classified into gastric (G type: N = 116), intestinal (I type: N = 49), pancreatobiliary (PB type: N = 14), and oncocytic types (O type: N = 3). Pancreatic volume of the contrast-enhanced computed tomography scan was measured using Ziostation2 software. Histological pancreatic parenchymal atrophy was also evaluated.

Results: AP occurred more frequently in I-types (I-type vs. G-type, 22.4% [11/49] vs 3.4% [4/116], P = 0.003) and PB-types (PB type vs. G-type, 35.7% [5/14] vs. 3.4% [4/116], P = 0.007) in comparison with G-types, which constituted the majority of the resected IPMNs. AP occurred more frequently in I-type patients with high pancreatic volumes (I-type with high pancreatic volume vs. I-type with low pancreatic volume, 37.0% [10/27] vs. 4.7% [1/21], P = 0.02). However, histological atrophy did not show an additional influence on the association between the incidence of AP and epithelial subtypes. The elevation of serum pancreatic enzymes was not significantly related to epithelial subtypes.

Conclusion: Epithelial subtypes and the degree of pancreatic volume may be closely associated with the incidence of AP in IPMN.
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http://dx.doi.org/10.1016/j.pan.2020.11.005DOI Listing
January 2021

Extraluminal recanalization for postoperative biliary obstruction using transseptal needle.

Surg Case Rep 2020 Dec 3;6(1):304. Epub 2020 Dec 3.

Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan.

Background: Postoperative biliary strictures are commonly related to accidental bile duct injuries or occur at the site of biliary anastomosis. The first-line treatment for benign biliary strictures is endoscopic therapy, which is less invasive and repeatable. However, recanalization for biliary complete obstruction is technically challenging to treat. The present report describes a successful case of treatment by extraluminal recanalization for postoperative biliary obstruction using a transseptal needle.

Case Presentation: A 66-year-old woman had undergone caudal lobectomy for the treatment of hepatocellular carcinoma. The posterior segmental branch of the bile duct was injured and repaired intraoperatively. Three months after the surgery, the patient had developed biliary leakage from the right hepatic bile duct, resulting in complete biliary obstruction. Since intraluminal recanalization with conventional endoscopic and percutaneous approaches with a guidewire failed, extraluminal recanalization using a transseptal needle with an internal lumen via percutaneous approach was performed under fluoroscopic guidance. The left lateral inferior segmental duct was punctured, and an 8-F transseptal sheath was introduced into the ostium of right hepatic duct. A transseptal needle was advanced, and the right hepatic duct was punctured by targeting an inflated balloon that was placed at the end of the obstructed right hepatic bile duct. After confirming successful puncture using contrast agent injected through the internal lumen of the needle, a 0.014-in. guidewire was advanced into the right hepatic duct. Finally, an 8.5-F internal-external biliary drainage tube was successfully placed without complications. One month after the procedure, the drainage tube was replaced with a 10.2-F drainage tube to dilate the created tract. Subsequent endoscopic internalization was performed 5 months after the procedure. At the 1-year follow-up examination, there was no sign of biliary obstruction and recurrence of hepatocellular carcinoma.

Conclusions: Recanalization using a transseptal needle can be an alternative technique for rigid biliary obstruction when conventional techniques fail.
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http://dx.doi.org/10.1186/s40792-020-01080-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714871PMC
December 2020

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

Application of hierarchical clustering to multi-parametric MR in prostate: Differentiation of tumor and normal tissue with high accuracy.

Magn Reson Imaging 2020 12 12;74:90-95. Epub 2020 Sep 12.

Philips Healthcare BIU MR, Asia Pacific, Konan 2-13-37, Minato-ku, Tokyo 108-8507, Japan.

Purpose: Hierarchical clustering (HC), an unsupervised machine learning (ML) technique, was applied to multi-parametric MR (mp-MR) for prostate cancer (PCa). The aim of this study is to demonstrate HC can diagnose PCa in a straightforward interpretable way, in contrast to deep learning (DL) techniques.

Methods: HC was constructed using mp-MR including intravoxel incoherent motion, diffusion kurtosis imaging, and dynamic contrast-enhanced MRI from 40 tumor and normal tissues in peripheral zone (PZ) and 23 tumor and normal tissues in transition zone (TZ). HC model was optimized by assessing the combinations of several dissimilarity and linkage methods. Goodness of HC model was validated by internal methods.

Results: Accuracy for differentiating tumor and normal tissue by optimal HC model was 96.3% in PZ and 97.8% in TZ, comparable to current clinical standards. Relationship between input (DWI and permeability parameters) and output (tumor and normal tissue cluster) was shown by heat maps, consistent with literature.

Conclusion: HC can accurately differentiate PCa and normal tissue, comparable to state-of-the-art diffusion based parameters. Contrary to DL techniques, HC is an operator-independent ML technique producing results that can be interpreted such that the results can be knowledgeably judged.
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http://dx.doi.org/10.1016/j.mri.2020.09.011DOI Listing
December 2020

Prediction of post-hepatectomy liver failure using gadoxetic acid-enhanced magnetic resonance imaging for hepatocellular carcinoma with portal vein invasion.

Eur J Radiol 2020 Sep 24;130:109189. Epub 2020 Jul 24.

Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.

Purpose: Accurate prediction of post-hepatectomy liver failure (PHLF) is important in advanced hepatocellular carcinoma (HCC). We aimed to retrospectively evaluate the utility of gadoxetic acid-enhanced MRI for predicting PHLF in patients who underwent anatomic hepatectomy for HCC with portal vein invasion.

Methods: Forty-one patients (32 men, 9 women) were included. Hepatobiliary-phase MR images were acquired 20 min after injection of gadoxetic acid using a 3D fat-suppressed T1-weighted spoiled gradient-echo sequence. Liver-spleen ratio (LSR), remnant hepatocellular uptake index (rHUI), and HUI were calculated. The severity of PHLF was defined according to the International Study Group of Liver Surgery. Differences in LSR between the resected liver and the remnant liver, and HUI and rHUI/HUI between no/mild and severe PHLF were compared using the Wilcoxon signed-rank test and Wilcoxon rank-sum test, respectively. Univariate and multivariate logistic regression analyses were performed to identify predictors of severe PHLF. Areas under the receiver operating characteristic curves (AUCs) of rHUI and rHUI/HUI were calculated for predicting severe PHLF.

Results: Nine patients developed severe PHLF. LSR of the remnant liver was significantly higher than that of the resected liver (P < 0.001). Severe PHLF demonstrated significantly lower rHUI (P < 0.001) and rHUI/HUI (P < 0.001) compared with no/mild PHLF. Multivariate logistic regression analysis showed that decreased rHUI (P = 0.012, AUC=0.885) and rHUI/HUI (P = 0.002, AUC=0.852) were independent predictors of severe PHLF.

Conclusion: Gadoxetic acid-enhanced MRI can be a promising noninvasive examination for assessing global and regional liver function, allowing estimation of the functional liver remnant and accurate prediction of severe PHLF before hepatic resection.
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http://dx.doi.org/10.1016/j.ejrad.2020.109189DOI Listing
September 2020

Prediction of pancreatic atrophy after steroid therapy using equilibrium-phase contrast computed tomography imaging in autoimmune pancreatitis.

JGH Open 2020 Aug 10;4(4):677-683. Epub 2020 Mar 10.

Division of Gastroenterology, Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan.

Background And Aims: Imaging tools for predicting pancreatic atrophy after steroid therapy in autoimmune pancreatitis (AIP) have not been established. As delayed equilibrium-phase contrast enhancement in computed tomography (CE-CT) may reflect interstitial fibrosis, we evaluated the ability of equilibrium-phase CT imaging for predicting pancreatic atrophy.

Methods: Forty-six steroid-treated AIP patients who underwent contrast-enhanced CT at our university hospital were included in this retrospective study. CT attenuation (Hounsfield units [HU]) values in noncontrast images (NC) and equilibrium-phase images (EP) and the differences in HU values between NC and EP images (SUB) were measured. Pancreatic volume was measured in CE-CT before (Vol) and after (Vol) steroid therapy. The volume reduction rate was calculated. The relationships of CT values with pancreatic atrophy, Vol, volume reduction rate, and diabetes exacerbation were investigated.

Results: CT values in the EP and SUB images before steroid therapy were associated with pancreatic atrophy after steroid therapy (atrophy nonatrophy 114.5 ± 12.8 99.5 ± 11.1, = 0.0002; 70.9 ± 14.72 57.2 ± 13.1, = 0.003, respectively), but CT values in NC images were not ( = 0.42). CT values in EP and SUB images before steroid therapy were correlated with Vol (EP images = -0.70, = 0.002; SUB images = -0.68, = 0.03) and volume reduction rate after steroid therapy (EP images: = -0.55, < 0.0001; SUB images = -0.45, = 0.002). Diabetes exacerbation was associated with higher EP and SUB values ( = 0.009 and = 0.04, respectively).

Conclusion: Equilibrium-phase contrast CT imaging may facilitate prediction of pancreatic atrophy after steroid therapy in AIP.
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http://dx.doi.org/10.1002/jgh3.12316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7411657PMC
August 2020

VI-RADS: Multiinstitutional Multireader Diagnostic Accuracy and Interobserver Agreement Study.

AJR Am J Roentgenol 2021 05 29;216(5):1257-1266. Epub 2020 Jul 29.

Department of Radiology, Kobe University Graduate School of Medicine and Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.

The Vesical Imaging Reporting and Data System (VI-RADS), based on multiparametric MRI (mpMRI), was developed to provide accurate information for the diagnosis of muscle-invasive bladder cancer (MIBC). The purpose of our study was to evaluate the interobserver agreement and diagnostic performance of VI-RADS among readers with different levels of experience. This retrospective study included 91 consecutive patients who underwent mpMRI before transurethral resection of bladder tumor (TURBT) from July 2010 through August 2018. After attending a training session, seven radiologists (five radiologists experienced in bladder MRI and two inexperienced radiologists) reviewed and scored all MRI examinations according to VI-RADS. The interobserver agreement was assessed by kappa statistics. ROC analysis was used to evaluate the diagnostic performance for MIBC. AUCs were estimated. Among 91 patients (72 men and 19 women; mean age ± SD, 73.2 ± 10.2 years), 48 (52.7%) had MIBC and 43 (47.3%) had non-muscle-invasive bladder cancer. Sixty-eight patients were treated with TURBT, and 23 were treated with radical cystectomy. Interobserver agreement was moderate to substantial (κ = 0.60-0.80) among the experienced readers, substantial (κ = 0.67) between the two inexperienced readers, and moderate to substantial (κ = 0.55-0.75) between the experienced and inexperienced readers. The pooled AUC was 0.88 (range, 0.82-0.91) for experienced readers and 0.84 (range, 0.83-0.85) for inexperienced readers, and 0.87 for all readers. Using a VI-RADS score of 4 or greater as the cutoff value for MIBC, the pooled sensitivity and specificity were 74.1% (range, 66.0-80.9%) and 94.1% (range, 88.6-97.7%) for experienced readers and 63.9% (range, 59.6-68.1%) and 86.4% (range, 84.1-88.6%) for inexperienced readers. Using a VI-RADS score of 3 or greater as the cutoff value, the pooled sensitivity and specificity were 83.4% (range, 80.9-85.1%) and 77.3% (range, 61.4-88.6%) for experienced readers and 82.0% (range, 80.9-83.0%) and 73.9% (range, 72.7-75.0%) for inexperienced readers. We observed moderate to substantial interobserver agreement and a pooled AUC of 0.87 among radiologists of different levels of expertise using VI-RADS. VI-RADS could help determine the depth and range of excision in TURBT, decreasing the risk of complications and enhancing the accuracy of pathologic diagnosis.
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http://dx.doi.org/10.2214/AJR.20.23604DOI Listing
May 2021

Magnetic resonance imaging of intraocular optic nerve disorders: review article.

Pol J Radiol 2020 7;85:e67-e81. Epub 2020 Feb 7.

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

The optic nerve is morphologically classified as a peripheral nerve, but histologically it shares characteristics with the central nerves. Diseases that affect vision and the optic nerve are many and varied: optic neuritis, demyelination (multiple sclerosis, acute disseminated encephalomyelitis, neuromyelitis optica spectrum disorder, and myelin oligodendrocyte glycoprotein antibody-related disorders), drugs, collagen disease, vasculitis, infection, trauma, vascular abnormalities, tumours, and non-tumoural masses. In this review, we summarise the magnetic resonance imaging findings for various pathological conditions that cause deterioration in visual acuity.
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http://dx.doi.org/10.5114/pjr.2020.93364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247023PMC
February 2020

Diagnostic performance of zero-TE lung MR imaging in FDG PET/MRI for pulmonary malignancies.

Eur Radiol 2020 Sep 16;30(9):4995-5003. Epub 2020 Apr 16.

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

Objectives: This study aimed to evaluate the diagnostic performance of the lung zero-echo time (ZTE) sequence in FDG PET/MRI for detection and differentiation of lung lesions in oncologic patients in comparison with conventional two-point Dixon-based MR imaging.

Methods: In this single-institution retrospective study approved by the institutional review board, 209 patients with malignancies (97 men and 112 women; age range, 17-89 years; mean age, 66.5 ± 12.9 years) underwent F-FDG PET/MRI between August 2017 and August 2018, with diagnostic Dixon and ZTE under respiratory gating acquired simultaneously with PET. Image analysis was performed for PET/Dixon and PET/ZTE fused images by two readers to assess the detectability and differentiation of lung lesions. The reference standard was pathological findings and/or the data from a chest CT. The detection and differentiation abilities were evaluated for all lesions and subgroups divided by lesion size and maximum standardized uptake value (SUVmax).

Results: Based on the reference standard, 227 lung lesions were identified in 113 patients. The detectability of PET/ZTE was significantly better than that of PET/Dixon for overall lesions, lesions with a SUVmax less than 3.0 and lesions smaller than 4 mm (p < 0.01). The diagnostic performance of PET/ZTE was significantly better than that of PET/Dixon for overall lesions and lesions smaller than 4 mm (p < 0.01).

Conclusions: ZTE can improve diagnostic performance in the detection and differentiation of both FDG-avid and non-FDG-avid lung lesions smaller than 4 mm in size, yielding a promising tool to enhance the utility of FDG PET/MRI in oncology patients with lung lesions.

Key Points: • The detection rate of PET/ZTE for lesions with a SUVmax of less than 1.0 was significantly better than that of PET/Dixon. • The performance for differentiation of PET/ZTE for lesions that were even smaller than 4 mm in size were significantly better than that of PET/Dixon. • Inter-rater agreement of PET/ZTE for the differentiation of lesions less than 4 mm in size was substantial and better than that of PET/Dixon.
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http://dx.doi.org/10.1007/s00330-020-06848-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431435PMC
September 2020

Assessment of lenvatinib treatment for unresectable hepatocellular carcinoma with liver cirrhosis.

HPB (Oxford) 2020 10 29;22(10):1450-1456. Epub 2020 Mar 29.

Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.

Background: The present study aimed to assess the clinical features of patients who received lenvatinib treatment for unresectable hepatocellular carcinoma (HCC).

Methods: The clinical characteristics, adverse events, and radiological responses were evaluated for 51 consecutive patients.

Results: Of the study subjects, 37 patients had Child-Pugh class A (CPA) liver function, and 14 patients had Child-Pugh class B (CPB) liver function. The overall response rates in the CPA and CPB groups were 42.9% and 25.0%, respectively, and disease control rates were 82.9% and 83.3%, respectively, without significant difference (p = 0.2621 and 0.9697). There was no significant difference between CPA and CPB groups regarding the incidence of adverse events, except for hepatic coma. No significant difference was observed in the relative dose intensity between the CPA and CPB groups, for the first month, 1-2 months, or 2-3 months (p = 0.2368, 0.9368, and 0.9293).

Conclusion: The comparable outcomes between the CPA and CPB groups suggest the acceptability of lenvatinib treatment in patients with impaired liver function, at least in the acute phase. With careful follow-up, the dose can be relatively intensified, even in patients with impaired liver function and this may contribute to offering comparable treatment.
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http://dx.doi.org/10.1016/j.hpb.2020.03.002DOI Listing
October 2020

CT angiography with 15 mL contrast material injection on time-resolved imaging for endovascular abdominal aortic aneurysm repair.

Eur J Radiol 2020 May 19;126:108861. Epub 2020 Feb 19.

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

Purpose: To assess the utility of whole-aorta CT angiography (CTA) with 15 mL contrast material (CM) on time-resolved imaging for endovascular abdominal aortic repair (EVAR).

Methods: Twenty-six patients with a high-risk of post-contrast acute kidney injury (PC-AKI) underwent CTA with 15 mL CM using temporal maximum intensity projection (tMIP-CTA) generated from time-resolved imaging. The aortoiliac CT values were measured. Two observers measured the arterial diameters in unenhanced CT and tMIP-CTA images, and image quality was evaluated on a 5-point scale. The presence of the accessory renal artery, inferior mesenteric artery (IMA) occlusion, and instructions for use (IFU) of EVAR were evaluated.

Results: CT examinations were successfully performed, and no patients developed PC-AKI. The mean CT values of the whole aorta were 267.5 ± 51.4 HU, which gradually decreased according to the distal levels of the aorta. Bland-Altman analysis revealed excellent agreement for the external arterial diameter measurements between unenhanced CT and tMIP-CTA. Excellent interobserver agreement was achieved for the measurements of the external (ICCs, 0.910-0.992) and internal arterial diameters (ICCs, 0.895-0.993). Excellent or good overall image quality was achieved in 24 (92 %) patients. The presence of the accessory renal artery, IMA occlusion and the assessment of IFU were in 100 % agreement. Multivariate analysis revealed aortic volume as the most significant independent factor associated with strong aortic enhancement (p = 0.004).

Conclusions: Whole-aorta tMIP-CTA on time-resolved imaging is useful for maintaining contrast enhancement and image quality for EVAR planning, and can substantially reduce the amount of CM.
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http://dx.doi.org/10.1016/j.ejrad.2020.108861DOI Listing
May 2020

Mid-term Outcomes and Predictors of Transarterial Embolization for Type II Endoleak After Endovascular Abdominal Aortic Aneurysm Repair.

Cardiovasc Intervent Radiol 2020 May 5;43(5):696-705. Epub 2020 Mar 5.

Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan.

Purpose: To evaluate the mid-term outcomes of transarterial embolization (TAE) for type II endoleak after endovascular abdominal aortic aneurysm repair (EVAR) and investigate the predictors of sac enlargement after embolization.

Materials And Methods: We conducted a retrospective analysis of 55 patients [48 men and 7 women, median age 79.0 (interquartile ranges 74-82) years] who underwent TAE for type II endoleak from 2010 to 2018. The aneurysmal sac enlargement, endoleaks, aneurysm-related adverse event rate, and reintervention rate were evaluated. Patients' characteristics and clinical factors were evaluated for their association with sac enlargement.

Results: Fifty-five patients underwent TAE with technical success and were subsequently followed for a median of 636 (interquartile ranges 446-1292) days. The freedom from sac enlargement rates at 1, 3, and 5 years was 73.2%, 32.0%, and 26.7%, respectively. After initial TAE, the recurrent type II, delayed type I, and occult type III endoleak were identified in 39 (71%), 5 (9%), and 3 (5%) patients, respectively. Although a patient had aorto-duodenal fistula, there was no aneurysm-related death. The freedom from reintervention rates was 84.6%, 35.7%, and 17.0%, respectively. In the multivariate analysis, sac diameter > 55 mm at initial TAE (hazard ratios, 3.23; 95% confidence intervals, 1.22-8.58; P < 0.05) was a significant predictor of sac enlargement.

Conclusion: TAE for type II endoleak was not effective in preventing sac enlargement, and reinterventions were required among the mid-term follow-up. The sac diameter > 55 mm at initial TAE was a significant predictor of sac enlargement.
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http://dx.doi.org/10.1007/s00270-020-02436-2DOI Listing
May 2020

Hepatic Artery Embolization Induces the Local Overexpression of Transforming Growth Factor β1 in a Rat Hepatoma Model.

Liver Cancer 2020 Jan 16;9(1):63-72. Epub 2019 Oct 16.

aDepartment of Diagnostic and Interventional Radiology, Kobe University, Kobe, Japan.

Introduction: The underlying mechanism involved in the recurrence of hepatoma after hepatic arterial embolization (HAE) is not adequately examined. An immunosuppressive cytokine, transforming growth factor β1 (TGF-β1), can lead to tumor progression and is affected by hypoxia in various cancers. The study aimed to assess the effect of HAE on the expression of TGF-β1 in a rat hepatoma model.

Methods: Sprague-Dawley rats bearing N1S1 hepatoma cells underwent HAE (HAE group, = 5) or sham treatment (sham group, = 4). The animals were euthanized at 48 h, and liver tissues were harvested. Immunohistochemistry (IHC) and quantitative polymerase chain reaction (qPCR) were performed to compare the expression of TGF-β1 and hypoxia-inducible factor 1α (HIF-1α) between the HAE and sham groups. In vitro experiments with the N1S1 cell line were also performed under normoxic (21% O2) or hypoxic (1% O2) conditions for 48 h, and the expression of TGF-β1 and HIF-1α was assessed with western blotting and enzyme-linked immunosorbent assay. Statistical data comparisons were performed by Student test.

Results: IHC showed that both the TGF-β1-positive and HIF-1α-positive tumor peripheral areas were larger in the HAE group (6.59 ± 2.49 and 10.26 ± 4.14%; < 0.001, respectively) than in the sham group (0.34 ± 0.41 and 0.40 ± 0.84% respectively). Similarly, qPCR showed that the mRNA expression levels of TGF-β1 and HIF-1α were higher (1.95 ± 0.38-fold and 1.62 ± 0.37-fold; < 0.001 and = 0.002, respectively) in the HAE group than those in the sham group. TGF-β1 expression was suppressed when HIF-1α inhibitors were added ( = 0.001), and HIF-1α expression was upregulated when exogenous TGF-β1 was added ( = 0.033) in N1S1 cells.

Conclusion: HAE enhanced local TGF-β1 expression in a rat hepatoma model. In vitro experiments suggest that HAE-induced hypoxic stress may trigger the interdependent expression of TGF-β1 and HIF-1α.
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http://dx.doi.org/10.1159/000502774DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7024851PMC
January 2020

Improved Visualization and Identification of the Right Adrenal Vein in 70-kVp Contrast-Enhanced Computed Tomography.

J Comput Assist Tomogr 2020 Jan/Feb;44(1):153-159

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

Objective: The aim of this study was to assess the utility of 70-kilovoltage-peak (kVp) contrast-enhanced computed tomography (CECT) for visualization and identification of the right adrenal vein (RAV) in comparison with that of conventional 120-kVp CECT.

Methods: This retrospective study included patients who underwent adrenal venous sampling with concurrent biphasic 120-kVp (120-kVp group, n = 43) or 70-kVp (70-kVp group, n = 47) CECT. Signal-to-noise ratios, contrast-to-noise ratios, longitudinal lengths, conspicuity scores, RAV detection rates, and size-specific dose estimates were compared between the 2 groups.

Results: In comparison with the 120-kVp group, the 70-kVp group had significantly higher signal-to-noise and contrast-to-noise ratios (P < 0.001-P = 0.033), greater longitudinal lengths (P < 0.001-P = 0.002), superior conspicuity scores for the RAV (P < 0.001), higher RAV detection rates (P = 0.015-P = 0.033), and lower size-specific dose estimates (P < 0.001).

Conclusions: Seventy-kilovoltage-peak CECT has advantages over conventional 120-kVp CECT and is potentially useful for noninvasive assessment of the precise anatomy of the RAV.
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http://dx.doi.org/10.1097/RCT.0000000000000960DOI Listing
January 2020

Sinusoidal-type Angiosarcoma of the Liver: Imaging Features and Potential Diagnostic Utility of p53 Immunostaining.

Am J Surg Pathol 2019 12;43(12):1728-1731

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

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http://dx.doi.org/10.1097/PAS.0000000000001349DOI Listing
December 2019

Dual-frequency MR elastography to differentiate between inflammation and fibrosis of the liver: Comparison with histopathology.

J Magn Reson Imaging 2020 04 18;51(4):1053-1064. Epub 2019 Aug 18.

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

Background: Differentiation between inflammation and fibrosis is an important clinical distinction in patients with chronic liver disease, which has been difficult so far with MR elastography.

Purpose: To investigate whether dual-frequency MR elastography can estimate necroinflammation of the liver and improve diagnostic performance for the staging of liver fibrosis.

Study Type: Retrospective.

Subjects: In all, 30 patients (14 males, 16 females) with chronic liver disease.

Field Strength/sequence: 1.5T/dual-frequency MR elastography at 60-Hz and 80-Hz vibration frequencies. [Correction added on November 12, 2019, after first online publication: The field strength in the preceding sentence was corrected.] ASSESSMENT: Necroinflammation activity and fibrosis were assessed using the METAVIR scoring system. Stiffness values at 60-Hz (G ) and 80-Hz (G ) were obtained with an MR elastogram. The difference value between G and G (ΔG) was calculated. Four values (G , G , G - ΔG, and G  + ΔG) were generated to estimate necroinflammation and fibrosis.

Statistical Tests: The ΔG were correlated with necroinflammation activity grade and fibrosis stage using Spearman's rank correlation. Diagnostic performance of the four values for necroinflammation activity grade and fibrous stage was assessed by using area under the receiver operating characteristic curve (AUC).

Results: The mean value of G (6.23 ± 3.67 kPa) was significantly higher than that of G (5.27 ± 3.14 kPa) (P < 0.0001). The ΔG demonstrated a strong correlation with necroinflammation grade (ρ = 0.625, P < 0.001) and no correlation with fibrosis stage (ρ = 0.306, P = 0.113). The AUC of the G and G  + ΔG showed higher accuracy for necroinflammation, and optimal cutoff values yielded better discrimination of ≥A1, ≥A2, and = A3. The AUC demonstrated that all the generated values had high diagnostic performance (≥0.87 for all) for fibrosis.

Data Conclusion: Dual-frequency MR elastography shows potential in estimating necroinflammation of the liver and may improve diagnostic performance for staging liver fibrosis.

Level Of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:1053-1064.
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http://dx.doi.org/10.1002/jmri.26903DOI Listing
April 2020

Type 1 Autoimmune Pancreatitis with Imaging Appearance Similar to That of Malignant Cystic Tumor.

Case Rep Gastroenterol 2019 May-Aug;13(2):265-270. Epub 2019 Jun 14.

Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.

A 79-year-old man was admitted with asymptomatic elevation of liver enzymes and tumor markers. Abdominal contrast-enhanced computed tomography demonstrated swelling of the pancreatic head, and additional blood test showed raised IgG4 levels. Histological examination by endoscopic ultrasonography (EUS)-guided fine needle aspiration for pancreatic head mass revealed storiform fibrosis and IgG4-positive plasma cell infiltration. We diagnosed this case as type 1 autoimmune pancreatitis (AIP). In addition, there was a cystic lesion in the pancreatic body apart from the pancreatic head mass. A mural nodule in the multilocular cyst was detected by EUS, and there was positive uptake of fluorodeoxyglucose in positron emission tomography/magnetic resonance imaging. The preoperative diagnosis of this cystic lesion was intraductal papillary mucinous carcinoma, and distal pancreatomy was performed. Histopathological findings showed various sizes of retention cysts caused by IgG4-positive plasma cell infiltration around the pancreatic branch ducts. The mural nodule was a fibrotic mass with diffuse infiltration of IgG4-positive cells. This cystic lesion mimicking malignant cystic neoplasm occurred in relation to AIP. This case provided important information helping to understand the mechanism of formation of mural nodules in multilocular cysts in patients with type 1 AIP.
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http://dx.doi.org/10.1159/000500477DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600027PMC
June 2019

Pancreatobiliary-type intraductal papillary mucinous neoplasm of the pancreas may have 2 subtypes with distinct clinicopathologic and genetic features.

Hum Pathol 2019 09 6;91:26-35. Epub 2019 Jun 6.

Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan; Institute of Liver Studies, King's College Hospital & King's College London, London SE5 9RS, United Kingdom. Electronic address:

We recently experienced cases of pancreatobiliary-type intraductal papillary mucinous neoplasms (PB-IPMNs) with imaging features resembling pancreatic ductal adenocarcinomas (PDACs), and histologic appearance of purely pancreatobiliary morphology and highly distorted papillary growth, which led to the present study aiming to systematically investigate PB-IPMNs in comparison with PDACs. Surgical cases of PB-IPMNs (n = 31) and PDACs (n = 24) were examined. PB-IPMNs were classified into monotypic tumors (n = 12; 39%) consisting of entirely high-grade pancreatobiliary-type neoplastic cells and polytypic cases (n = 19; 61%) associated with components of low-grade dysplasia and/or other histologic types (eg, gastric, intestinal, or oncocytic types). Clinically, monotypic PB-IPMNs less commonly had dilatation of the ampullary orifice (0% versus 74%) and mucin hypersecretion (17% versus 89%) than did polytypic cases. In most cases of monotypic PB-IPMNs, cystic dilatation of the lesional ducts was less obvious on imaging; therefore, 33% were radiologically diagnosed as PDACs. Histologically, intraductal tumors in monotypic cases showed a highly complex papillary architecture with tubular/cribriform glands and irregular branching, and all these cases were associated with invasive malignancy. GNAS mutations were detected in polytypic PB-IPMNs (6/19; 32%), but there were no GNAS mutations in monotypic cases. The recurrence-free survival of patients with monotypic PB-IPMN or PDAC was similar and significantly worse than that of patients with polytypic PB-IPMN. In conclusion, some cases of monotypic PB-IPMNs lacked the classic characteristics of IPMNs and shared features with PDACs, raising the possibility that these cases may be better classified as a papillary variant of PDACs rather than IPMNs.
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http://dx.doi.org/10.1016/j.humpath.2019.05.010DOI Listing
September 2019
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