Publications by authors named "Kousei Ishigami"

166 Publications

Radiology- and gene-based risk stratification in small renal cell carcinoma: A preliminary study.

PLoS One 2021 7;16(9):e0256471. Epub 2021 Sep 7.

Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Purpose: Most small renal cell carcinomas (small RCCs) will remain indolent after detection, but some stage I RCCs still metastasize. There are no risk-stratification imaging factors that could be used to identify poor-prognosis patients based on genomic profiling. Here, we evaluated the relationships between imaging parameters and RNA expressions in small RCC and attempted to identify imaging factors that could be used as effective biomarkers.

Methods: We acquired biopsy specimens of 18 clear cell carcinomas that had undergone perfusion CT (pCT) and MRI between April 2018 and March 2019. We performed RNA sequencing, assessed RNA expressions, and calculated each tumor's cell-cycle progression (CCP) score, which has prognostic value in predicting metastatic progression. We classified the tumors into two groups: clear cell type A (ccA) and type B (ccB). CcA has better survival compared to ccB. We evaluated the following characteristics of each tumor: tumor size, presence of pseudocapsule, and fat. We used the pCT and MRI to measure each tumor's volume transfer constant (Ktrans), rate constant (Kep), extracellular extravascular volume fraction (VE), fractional plasma volume (VP), and apparent diffusion coefficient (ADC). The correlations between these small RCC imaging parameters and the tumor size and RNA expressions were determined.

Results: The tumor size was significantly correlated with Kep and inversely correlated with VE, VP, ADC, and hallmark angiogenesis. The CCP score was significantly inversely correlated with Ktrans and Kep. The ccA tumors tended to show a pseudocapsule on MRI.

Conclusion: Tumor size was correlated with low perfusion, but not with prognostic factors based on genomic profiling. Imaging parameters (e.g., Ktrans and Kep) and tumor characteristics (e.g., pseudocapsule) may enable gene-based risk stratification in small RCC.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256471PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8423232PMC
September 2021

The Evolving Genomic Landscape of Esophageal Squamous Cell Carcinoma Under Chemoradiotherapy.

Cancer Res 2021 Aug 19. Epub 2021 Aug 19.

Department of Pathology and Tumor biology, Graduate School of Medicine, Kyoto University.

Esophageal squamous cell carcinoma (ESCC) often recurs after chemoradiotherapy (CRT), and the prognosis of ESCC after CRT has not improved over the past few decades. The mutation process in CRT-resistant clones and the functional relevance of genetic alterations remain unclear. To address these problems, we performed whole-exome sequencing of 52 tumor samples from 33 ESCC patients who received radiotherapy combined with 5-fluorouracil/platinum. In multi-region analyses of pretreatment and locally recurrent lesions from five cases, most driver gene-altered clones remained under CRT selection pressure, while few driver gene alterations were acquired at recurrence. The mutation signatures of recurrent ESCC, including increased deletion frequency and platinum dose-dependent base substitution signatures, were substantially different from those of primary ESCC and reflected the iatrogenic impacts of CRT. Single-region analysis of 28 pretreatment tumors indicated that focal copy number gain at the MYC locus was significantly associated with poor progression-free survival and overall survival after CRT. MYC gain remained throughout the CRT course and potentially contributes to intrinsic resistance to CRT. Consistent with these findings, MYC copy number and mRNA and protein levels in ESCC cell lines correlated positively with resistance to radiotherapy, and MYC knockdown improved sensitivity to radiotherapy. Overall, these data characterize the clonal evolution process induced by CRT and clinically relevant associations for genetic alterations in ESCC. These findings increase our understanding of therapeutic resistance and support the rationale for precision CRT.
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http://dx.doi.org/10.1158/0008-5472.CAN-21-0653DOI Listing
August 2021

Papillary craniopharyngioma coexisting with an intratumoral abscess in a pediatric patient: A case report and review of the literature.

Acta Radiol Open 2021 Jul 30;10(7):20584601211030661. Epub 2021 Jul 30.

Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Craniopharyngiomas are benign neoplasms with two histological subtypes: adamantinomatous and papillary. Papillary craniopharyngiomas are rare in children, and those with a pituitary abscess within are even rarer. Herein, we present the case of a 14-year-old boy with a papillary craniopharyngioma and a coexisting intratumoral abscess, who was hospitalized for persistent pyrexia, polyuria, and polydipsia. The absence of calcification on computed tomography, high signal intensity inside the tumor on diffusion-weighted imaging, and clinical findings such as fever, a high inflammatory response, and meningitis, as well as short-term morphological changes on imaging, could aid in diagnosis.
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http://dx.doi.org/10.1177/20584601211030661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8327242PMC
July 2021

Impact of Metabolic Activity in Hepatocellular Carcinoma: Association With Immune Status and Vascular Formation.

Hepatol Commun 2021 Jul 26;5(7):1278-1289. Epub 2021 Mar 26.

Department of Surgery and Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan.

We evaluated the prognostic value of fluorine-18 fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) in hepatocellular carcinoma (HCC). Their association with programmed death ligand 1 (PD-L1) expression and vascular formation was further investigated. In this retrospective study, using a database of 418 patients who had undergone F-FDG PET/CT before hepatic resection for HCC, immunohistochemical staining of PD-L1, clusters of differentiation (CD) 8, CD68, and CD34 was performed. Patients with a high maximum standardized uptake value (SUVmax) on F-FDG PET/CT showed a significantly worse recurrence-free survival (RFS) (hazard ratio [HR]: 1.500; 95% confidence interval [CI]: 1.088-2.069;  = 0.0133) and overall survival (OS) (HR: 2.259; 95% CI: 1.276-4.000;  = 0.0052) than patients with a low SUVmax. Logistic regression analysis showed that a high SUVmax in HCC was significantly associated with PD-L1-positive expression (odds ratio: 4.407; 95% CI: 2.265-8.575;  < 0.0001). SUVmax values of HCC were associated with intratumoral CD8-positive T-cell counts ( = 0.0044) and CD68-positive macrophage counts ( = 0.0061). Stratification based on SUVmax, PD-L1 expression, and the vessels that encapsulate tumor clusters (VETC) status was also significantly associated with RFS and OS. SUVmax, VETC, and PDL1 expression were independently predictive of survival on multivariable analysis. Our large cohort study showed that a high SUVmax on F-FDG PET/CT is associated with a poor clinical outcome and PD-L1 expression in patients with HCC. Additionally, stratification of patients based on the combination of SUVmax, PD-L1 expression, and the VETC status predicts poor clinical outcome.
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http://dx.doi.org/10.1002/hep4.1715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279470PMC
July 2021

Impact and risk factors for skeletal muscle mass loss after hepatic resection in patients with hepatocellular carcinoma.

JGH Open 2021 Jul 10;5(7):785-792. Epub 2021 Jun 10.

Department of Surgery and Science, Graduate School of Medical Sciences Kyushu University Fukuoka Japan.

Background And Aim: The aims of this study were to determine whether a postoperative decrease in skeletal muscle mass (SMM) after hepatic resection can predict long-term outcomes in patients with hepatocellular carcinoma (HCC) and identify risk factors for SMM loss in patients who undergo hepatic resection.

Methods: This was a large retrospective study of 400 patients who underwent hepatic resection for HCC and pre- and postoperative computed tomography (CT) scans. SMM was measured at the third lumbar vertebrae, and the postoperative change in SMM compared with preoperative values was calculated as Δ SMM. The cutoff value for the post-/preoperative ratio was set at 0.9.

Results: Sixty patients (15.0%) developed SMM loss. These patients had a significantly prolonged prothrombin time ( = 0.0092), longer duration of surgery ( = 0.0021), more blood loss ( = 0.0040), and higher rate of postoperative complications ( = 0.0037) than those without SMM loss. Multivariate analysis revealed that prolonged prothrombin time and postoperative complications were independent risk factors for SMM loss after hepatic resection. Patients with SMM loss had significantly shorter overall survival ( = 0.0018) than the other patients had. SMM loss was an independent prognostic factor for overall survival (hazard ratio 1.551, 95% confidential interval 1.028-2.340,  = 0.0363).

Conclusions: We demonstrated an association of SMM loss with postoperative complications and long-term prognosis in patients with HCC. Patients with prolonged prothrombin time, or postoperative complications, may need to maintain their SMM. Further prospective studies are needed to investigate whether nutritional support can improve SMM loss.
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http://dx.doi.org/10.1002/jgh3.12588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264232PMC
July 2021

A case of KIT negative extra-gastrointestinal stromal tumor arising in the greater omentum with predominant cystic formation.

Radiol Case Rep 2021 Aug 20;16(8):2315-2318. Epub 2021 Jun 20.

Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.

We report a rare case of KIT-negative extra-gastrointestinal stromal tumor, in a 40-year-old woman. Contrast-enhanced computed tomography and magnetic resonance imaging revealed a >15-cm mass of multiple cystic lesions in the greater omentum. Histopathological findings after surgery showed a sheet-like growth of stellate tumor cells from epithelial cells, cystic degeneration, and mucus-like stroma. Immunohistochemistry was positive for discovered on GIST-1 (DOG1) but negative for CD117 (c-kit).
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http://dx.doi.org/10.1016/j.radcr.2021.05.061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237296PMC
August 2021

Measurement of circumferential tumor extent of colorectal cancer on CT colonography: relation to clinicopathological features and patient prognosis after surgery.

Jpn J Radiol 2021 May 22. Epub 2021 May 22.

Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.

Purpose: To examine the relationship between circumferential tumor extent of colorectal cancer (CRC) on CT colonography (CTC) and clinicopathological features including patient prognosis after surgery.

Materials And Methods: This retrospective study performed at our institution from January 2013 to December 2019 enrolled 195 consecutive patients (110 men, 85 women; mean age, 64.7 years) with CRC evaluated by contrast-enhanced CTC before surgery. The circumferential tumor extent rate (CER) was measured by CTC in virtual colon dissection (VCD) mode to examine the relation between the CER and clinicopathological features and patient prognosis.

Results: CER had association with tumor invasion depth (T), nodal involvement (N), distant metastasis (M), and stage. The Kruskal-Wallis tests showed significant difference for T, N and the stage (p < 0.0001, p = 0.0021 and p < 0.0001) and Wilcoxon rank sum test showed significant difference for M (p = 0.0015). According to the log-rank test, there were no significant differences in OS or DFS between patients with high and low CER.

Conclusion: Circumferential tumor extent was significantly correlated with TNM categories and stage of CRC, but not with patient prognosis after surgery.
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http://dx.doi.org/10.1007/s11604-021-01141-5DOI Listing
May 2021

Dynamic Chest Radiography of Pulmonary Arteriovenous Malformation.

Radiology 2021 Aug 18;300(2):285. Epub 2021 May 18.

From the Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.

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http://dx.doi.org/10.1148/radiol.2021204631DOI Listing
August 2021

Congestion Area of the Right Lobe Graft in Living Donor Liver Transplantation: Quantitative Evaluation of Hemodynamics Using Computed Tomography Perfusion.

Transplant Proc 2021 Jun 4;53(5):1653-1658. Epub 2021 May 4.

Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Background: The hemodynamics of congestion areas in the right lobe graft after living donor liver transplantation (LDLT) remains unclear. The aim of this study was to elucidate the hemodynamics of congestion areas in the right lobe graft after LDLT using computed tomography (CT) perfusion imaging and the dual-input maximum slope method.

Methods: Sixteen recipients underwent CT perfusion of the liver and portal phase abdominal to pelvic CT 1week after LDLT using a right lobe graft. The attenuation of segments V and VIII on the portal venous phase abdominal to the pelvic CT scan was classified into 3 categories: hyperattenuation, iso-attenuation, and hypoattenuation. Mean arterial blood flow (AF, mL/min/100 mL tissue), portal blood flow (PF, mL/min/100 mL tissue), and perfusion index (%) [PI = AF/(AF + PF) × 100] were compared between the hyperattenuation group and iso-attenuation group. The independent t test was used for these statistical analyses.

Results: On the portal phase abdominal scan, 15 segments, 16 segments, and 1 segment showed hyperattenuation, iso-attenuation, and hypoattenuation, respectively. The mean AF and PI of the hyperattenuation group (44.4 ± 24.4, 30.2 ± 13.5) were significantly higher than those of the iso-attenuation group (28.0 ± 7.8, 19.9 ± 6.2) (P < .05, P < .05).

Conclusions: The congested liver segments showed high AF and high PI on CT perfusion imaging. This method enables the feasible quantification of the hemodynamics and the description of focal hemodynamic change in the graft after LDLT.
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http://dx.doi.org/10.1016/j.transproceed.2021.02.024DOI Listing
June 2021

Differentiating Liver Hemangioma from Metastatic Tumor Using T2-enhanced Spin-echo Imaging with a Time-reversed Gradient-echo Sequence in the Hepatobiliary Phase of Gadoxetic Acid-enhanced MR Imaging.

Magn Reson Med Sci 2021 Apr 20. Epub 2021 Apr 20.

Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University.

Purpose: To evaluate the utility of T2-enhanced spin-echo imaging using the time-reversed gradient echo sequence (T2FFE imaging) in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI (Gd-EOB-MRI) for differentiating hemangiomas from metastatic tumors.

Methods: A total of 61 patients with 133 liver lesions, including 37 hemangiomas and 96 metastatic tumors, were scanned by Gd-EOB-MRI. Four data sets were independently analyzed by two readers: (1) 3D fat-suppressed T2-weighted imaging (FS-T2WI) alone; (2) the combination of 3D FS-T2WI and T2FFE imaging in the HBP of Gd-EOB-MRI; (3) the combination of 3D FS-T2WI, diffusion-weighted imaging (DWI) with the b-value of 1000 s/mm and the apparent diffusion coefficient (ADC); and (4) a dynamic study of Gd-EOB-MRI. After classifying the lesion sizes as ≤ 10 mm or > 10 mm, we conducted a receiver-operating characteristic analysis to compare diagnostic accuracies among the four data sets for differentiating hemangiomas from metastatic tumors.

Results: The areas under the curves (AUCs) of the four data sets of two readers were: (1) ≤ 10 mm (0.85 and 0.91) and > 10 mm (0.88 and 0.97), (2) ≤ 10 mm (0.94 and 0.94) and > 10 mm (0.96 and 0.95), (3) ≤ 10 mm (0.90 and 0.87) and > 10 mm (0.89 and 0.95), and (4) ≤ 10 mm (0.62 and 0.67) and > 10 mm (0.76 and 0.71), respectively. Data sets (2) and (3) showed no significant differences in AUCs, but both showed significantly higher AUCs compared to that of (4) regardless of the lesion size (P < 0.05).

Conclusion: The combination of 3D FS-T2WI and T2FFE imaging in the HBP of Gd-EOB-MRI achieved an accuracy equivalent to that of the combination of 3D FS-T2WI, DWI, and ADC and might be helpful in differentiating hemangiomas from metastatic tumors.
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http://dx.doi.org/10.2463/mrms.mp.2020-0151DOI Listing
April 2021

Progression of traction bronchiectasis/bronchiolectasis in interstitial lung abnormalities is associated with increased all-cause mortality: Age Gene/Environment Susceptibility-Reykjavik Study.

Eur J Radiol Open 2021 10;8:100334. Epub 2021 Mar 10.

Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.

Purpose: The aim of this study is to assess the role of traction bronchiectasis/bronchiolectasis and its progression as a predictor for early fibrosis in interstitial lung abnormalities (ILA).

Methods: Three hundred twenty-seven ILA participants out of 5764 in the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study who had undergone chest CT twice with an interval of approximately five-years were enrolled in this study. Traction bronchiectasis/bronchiolectasis index (TBI) was classified on a four-point scale: 0, ILA without traction bronchiectasis/bronchiolectasis; 1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion; 2, ILA with mild to moderate traction bronchiectasis; 3, ILA and severe traction bronchiectasis and/or honeycombing. Traction bronchiectasis (TB) progression was classified on a five-point scale: 1, Improved; 2, Probably improved; 3, No change; 4, Probably progressed; 5, Progressed. Overall survival (OS) among participants with different TB Progression Score and between the TB progression group and No TB progression group was also investigated. Hazard radio (HR) was estimated with Cox proportional hazards model.

Results: The higher the TBI at baseline, the higher TB Progression Score (P < 0.001). All five participants with TBI = 3 at baseline progressed; 46 (90 %) of 51 participants with TBI = 2 progressed. TB progression was also associated with shorter OS with statistically significant difference (adjusted HR = 1.68, P < 0.001).

Conclusion: TB progression was visualized on chest CT frequently and clearly. It has the potential to be the predictor for poorer prognosis of ILA.
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http://dx.doi.org/10.1016/j.ejro.2021.100334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960545PMC
March 2021

Obesity is a risk factor for intrahepatic cholangiocarcinoma progression associated with alterations of metabolic activity and immune status.

Sci Rep 2021 Mar 12;11(1):5845. Epub 2021 Mar 12.

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.

Body mass index (BMI) is well known to be associated with poor prognosis in several cancers. The relationship between BMI and the long-term outcomes of patients with intrahepatic cholangiocarcinoma (ICC) is incompletely understood. This study investigated the relationships of BMI with clinicopathological characteristics and patient outcomes, focusing on metabolic activity and immune status. The relationship between BMI and the maximum standardized uptake value (SUVmax) on fluorine-18 fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) was analyzed. In addition, immunohistochemistry was performed for programmed cell death-ligand 1 (PD-L1), cluster of differentiation 8 (CD8), and forkhead box protein P3 (Foxp3). Seventy-four patients with ICC were classified into normal weight (BMI < 25.0 kg/m, n = 48) and obesity groups (BMI ≥ 25.0 kg/m, n = 26), respectively. Serum carbohydrate antigen 19-9 levels were higher in the obesity group than in the normal weight group. Tumor size and the intrahepatic metastasis rate were significantly larger in the obesity group. Patients in the obesity group had significantly worse prognoses than those in the normal weight group. Moreover, BMI displayed a positive correlation with SUVmax on F-FDG PET/CT (n = 46, r = 0.5152). Patients with high F-FDG uptake had a significantly higher rate of PD-L1 expression, lower CD8 + tumor-infiltrating lymphocyte (TIL) counts, and higher Foxp3 + TIL counts. The elevated BMI might predict the outcomes of patients with ICC. Obesity might be associated with ICC progression, possibly through alterations in metabolic activity and the immune status.
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http://dx.doi.org/10.1038/s41598-021-85186-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955092PMC
March 2021

I metaiodobenzylguanidine (MIBG) uptake predicts early relapse of neuroblastoma using semi-quantitative SPECT/CT analysis.

Ann Nucl Med 2021 May 14;35(5):549-556. Epub 2021 Feb 14.

Department of Clinical Radiology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan.

Objective: I metaiodobenzylguanidine (MIBG) scintigraphy is a useful tool for the diagnosis of neuroblastoma (NB). MIBG uptake is correlated with norepinephrine transporter expression; hence, it is expected that high-MIBG tumors would be more highly differentiated and have a better prognosis than those with lower expression. We have introduced a method of assessing MIBG accumulation semi-quantitatively using SPECT/CT fusion images. The purpose of this study was to evaluate the relationship of I MIBG uptake measured by semi-quantitative values of SPECT/CT and early relapse of NB.

Methods: We studied the cases of 11 patients (5 males and 6 females, age 5-65 months, median age 20 months) with histopathologically proven NB between April 2010 and March 2015. The early-relapse group was defined as patients who had relapsed within 3 years after the first I MIBG SPECT/CT exam. Other patients were classified as the delay-relapse group. Uptake of MIBG was evaluated using the count ratio of tumor and muscles. T/Mmax and T/Mmean were defined as follows: T/Mmax = max count of tumor/max count of muscle, T/Mmean = mean count of tumor/mean count of muscle.

Results: The average T/Mmean values of the early-relapse group and delay-relapse group were 2.65 ± 0.58 and 7.66 ± 2.68, respectively. The T/Mmean values of the early-relapse group were significantly lower than those of delay-relapse group (p < 0.05). The average T/Mmax of the early-relapse group and delay-relapse group were 8.86 ± 3.22 and 16.20 ± 1.97, respectively. There was no significant difference in T/Mmax values between the two groups.

Conclusions: Low I MIBG uptake using semi-quantitative SPECT/CT analysis was correlated with early relapse of NB.
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http://dx.doi.org/10.1007/s12149-021-01595-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8079305PMC
May 2021

Noninvasive assessment of liver fibrosis by dual-layer spectral detector CT.

Eur J Radiol 2021 Mar 30;136:109575. Epub 2021 Jan 30.

Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address:

Purpose: To elucidate the diagnostic ability of liver fibrosis using (1) liver parenchymal iodine density on equilibrium computed tomographic imaging and (2) extracellular volume (ECV) measured by dual-layer spectral detector CT.

Methods: From April 2018 to June 2019, 68 patients [mean age, 62 years; 39 males, 29 females] underwent dynamic contrast-enhanced CT by a dual-layer spectral detector CT system before liver transplantation or liver resection. The iodine densities of liver parenchyma (I ) and aorta (I ) were independently measured by two radiologists at the equilibrium phase. The iodine-density ratio (I-ratio) (I / I ) and the CT-ECV were calculated. Spearman's rank correlation coefficient was used to analyze the relationship between the I-ratio or the CT-ECV and the fibrosis stage. A receiver operating characteristic (ROC) curve analysis was performed to determine the accuracy of the I-ratio and the CT-ECV for discriminating fibrosis stages.

Results: For both readers, the I-ratio and the CT-ECV increased significantly as the fibrosis stage advanced (I-ratio: rho = 0.380 and 0.443, p < 0.01; CT-ECV: rho = 0.423 and 0.469, p < 0.01). The CT-ECV showed better diagnostic accuracy for staging fibrosis, and the area under the ROC curve values for discriminating F4 stage were 0.884 and 0.925. The two readers' cutoff values of the CT-ECV for diagnosing fibrosis as F4 were 26.2 % and 29.3 %, with 95.0 % and 90.0 % sensitivity and 72.9 % and 85.4 % specificity, respectively.

Conclusion: The liver parenchymal iodine density on the equilibrium phase and the CT-ECV can be useful for predicting a high stage of liver fibrosis.
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http://dx.doi.org/10.1016/j.ejrad.2021.109575DOI Listing
March 2021

Spectrum of Pulmonary Fibrosis from Interstitial Lung Abnormality to Usual Interstitial Pneumonia: Importance of Identification and Quantification of Traction Bronchiectasis in Patient Management.

Korean J Radiol 2021 05 21;22(5):811-828. Epub 2020 Dec 21.

Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.

Following the introduction of a novel pathological concept of usual interstitial pneumonia (UIP) by Liebow and Carrington in 1969, diffuse interstitial pneumonia has evolved into UIP, nonspecific interstitial pneumonia (NSIP), and interstitial lung abnormality (ILA); the histopathological and CT findings of these conditions reflect the required multidisciplinary team approach, involving pulmonologists, radiologists, and pathologists, for their diagnosis and management. Concomitantly, traction bronchiectasis and bronchiolectasis have been recognized as the most persistent and important indices of the severity and prognosis of fibrotic lung diseases. The traction bronchiectasis index (TBI) can stratify the prognoses of patients with ILAs. In this review, the evolutionary concepts of UIP, NSIP, and ILAs are summarized in tables and figures, with a demonstration of the correlation between CT findings and pathologic evaluation. The CT-based UIP score is being proposed to facilitate a better understanding of the spectrum of pulmonary fibrosis, from ILAs to UIP, with emphasis on traction bronchiectasis/bronchiolectasis.
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http://dx.doi.org/10.3348/kjr.2020.1132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076826PMC
May 2021

A novel fast kilovoltage switching dual-energy CT with deep learning: Accuracy of CT number on virtual monochromatic imaging and iodine quantification.

Phys Med 2021 Jan 25;81:253-261. Epub 2021 Jan 25.

Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.

Purpose: A novel fast kilovoltage switching dual-energy CT with deep learning [Deep learning based-spectral CT (DL-Spectral CT)], which generates a complete sinogram for each kilovolt using deep learning views that complement the measured views at each energy, was commercialized in 2020. The purpose of this study was to evaluate the accuracy of CT numbers in virtual monochromatic images (VMIs) and iodine quantifications at various radiation doses using DL-Spectral CT.

Materials And Methods: Two multi-energy phantoms (large and small) using several rods representing different materials (iodine, calcium, blood, and adipose) were scanned by DL-Spectral CT at varying radiation doses. Images were reconstructed using three reconstruction parameters (body, lung, bone). The absolute percentage errors (APEs) for CT numbers on VMIs at 50, 70, and 100 keV and iodine quantification were compared among different radiation dose protocols.

Results: The APEs of the CT numbers on VMIs were <15% in both the large and small phantoms, except at the minimum dose in the large phantom. There were no significant differences among radiation dose protocols in computed tomography dose index volumes of 12.3 mGy or larger. The accuracy of iodine quantification provided by the body parameter was significantly better than those obtained with the lung and bone parameters. Increasing the radiation dose did not always improve the accuracy of iodine quantification, regardless of the reconstruction parameter and phantom size.

Conclusion: The accuracy of iodine quantification and CT numbers on VMIs in DL-Spectral CT was not affected by the radiation dose, except for an extremely low radiation dose for body size.
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http://dx.doi.org/10.1016/j.ejmp.2020.12.018DOI Listing
January 2021

Right Ventricular Extracellular Volume with Dual-Layer Spectral Detector CT: Value in Chronic Thromboembolic Pulmonary Hypertension.

Radiology 2021 Mar 26;298(3):589-596. Epub 2021 Jan 26.

From the Departments of Clinical Radiology (Y.Y., T.K., K.S., T.H., Y.M., K.I.), Cardiovascular Medicine (K.A., K. Hosokawa), and Health Sciences (H.Y.), Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan; Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan (K. Hioki); and Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan (M.N.).

Background Right ventricular (RV) extracellular volumes (ECVs), as a surrogate for histologic fibrosis, have not been sufficiently investigated. Purpose To evaluate and compare RV and left ventricular (LV) ECVs obtained with dual-layer spectral detector CT (DLCT) in chronic thromboembolic pulmonary hypertension (CTEPH) and investigate the clinical importance of RV ECV. Materials and Methods Retrospective analysis was performed on data from 31 patients with CTEPH (17 were not treated with pulmonary endarterectomy [PEA] or balloon pulmonary angioplasty [BPA] and 14 were) and eight control subjects who underwent myocardial delayed enhancement (MDE) DLCT from January 2019 to June 2020. The ECVs in the RV and LV walls were calculated by using iodine density as derived from spectral data pertaining to MDE. Statistical analyses were performed with one-way repeated analysis of variance with the Tukey post hoc test or the Kruskal-Wallis test with the Steel-Dwass test and linear regression analysis. Results The PEA- and BPA-naive group showed significantly higher ECVs than the PEA- or BPA-treated group and control group in the septum (28.2% ± 2.9 vs 24.3% ± 3.6, = .005), anterior right ventricular insertion point (RVIP) (32.9% ± 4.6 vs 25.3% ± 3.6, < .001), posterior RVIP (35.2% ± 5.2 vs 27.3% ± 4.2, < .001), mean RVIP (34.0% ± 4.2 vs 26.3% ± 3.4, < .001), RV free wall (29.5% ± 3.3 vs 25.9% ± 4.1, = .036), and mean RV wall (29.1% ± 3.0 vs 26.1% ± 3.1, = .029). There were no significant differences between the PEA- or BPA-treated group and control subjects in these segments (septum, = .93; anterior RVIP, = .38; posterior RVIP, = .52; mean RVIP, = .36; RV free wall, = .97; and mean RV, = .33). There were significant correlations between ECV and mean pulmonary artery pressure (PAP) or brain natriuretic peptide (BNP) in the mean RVIP (mean PAP: = 0.66, < .001; BNP: = 0.44, = .014) and the mean RV (mean PAP: = 0.49, = .005; BNP: = 0.44, = .013). Conclusion Right ventricular and right ventricular insertion point extracellular volumes could be noninvasive surrogate markers of disease severity and reverse tissue remodeling in chronic thromboembolic pulmonary hypertension. © RSNA, 2021 See also the editorial by Sandfort and Bluemke in this issue.
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http://dx.doi.org/10.1148/radiol.2020203719DOI Listing
March 2021

Surgically resected hepatic mass caused by fascioliasis.

Clin J Gastroenterol 2021 Apr 20;14(2):662-667. Epub 2021 Jan 20.

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.

Fascioliasis is a parasitic infestation caused by the digenetic trematodes Fasciola hepatica and F. gigantica. It is not commonly seen in developed countries, so diagnosis there is always difficult as a result of confusion with other hepatic or biliary disorders. A 56-year-old man presented at our hospital with a hepatic mass that had been inadvertently discovered by ultrasonography. Abdominal computed tomography revealed a multi-cystic lesion distributed along the branch of the right bile duct. Endoscopic retrograde cholangiopancreatography showed serrated changes ranging from the upper level of the common bile duct to the right hepatic bile duct. Eosinophilia was not observed and tumor marker levels were within normal ranges. Following right lobectomy combined with bile duct reconstruction, a histological examination revealed cholangitis with inflammatory cell infiltration accompanied by parasite egg-like structures and Charcot-Leyden crystals. An additional serologic test was positive for F. hepatica antibodies. A diagnosis of fascioliasis was thus confirmed by histopathology and serology. Fascioliasis should be suspected if imaging findings such as multiple small hypodense lesions in the liver are observed, and serologic tests can be useful for differential diagnosis.
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http://dx.doi.org/10.1007/s12328-021-01339-0DOI Listing
April 2021

Dynamic Chest X-Ray Using a Flat-Panel Detector System: Technique and Applications.

Korean J Radiol 2021 04 30;22(4):634-651. Epub 2020 Nov 30.

Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Dynamic X-ray (DXR) is a functional imaging technique that uses sequential images obtained by a flat-panel detector (FPD). This article aims to describe the mechanism of DXR and the analysis methods used as well as review the clinical evidence for its use. DXR analyzes dynamic changes on the basis of X-ray translucency and can be used for analysis of diaphragmatic kinetics, ventilation, and lung perfusion. It offers many advantages such as a high temporal resolution and flexibility in body positioning. Many clinical studies have reported the feasibility of DXR and its characteristic findings in pulmonary diseases. DXR may serve as an alternative to pulmonary function tests in patients requiring contact inhibition, including patients with suspected or confirmed coronavirus disease 2019 or other infectious diseases. Thus, DXR has a great potential to play an important role in the clinical setting. Further investigations are needed to utilize DXR more effectively and to establish it as a valuable diagnostic tool.
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http://dx.doi.org/10.3348/kjr.2020.1136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005348PMC
April 2021

Cryoablation for Secondary Renal Cell Carcinoma After Surgical Nephrectomy.

Cardiovasc Intervent Radiol 2021 Mar 17;44(3):414-420. Epub 2020 Nov 17.

Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.

Purpose: To retrospectively evaluate the clinical outcomes of cryoablation for secondary renal cell carcinoma for patients with a history of nephrectomy for initial renal cell carcinoma.

Materials And Methods: Thirty patients with 40 renal tumors who had undergone a nephrectomy for initial renal cell carcinoma and cryoablation for renal cell carcinoma as a secondary treatment during the period from April 2014 to December 2018 at a single center institution were enrolled. The patients' overall survival, local control, relapse-free survival, change of renal function, and complications were evaluated. The clinical factors of relapse-free survival were also evaluated.

Results: The 5 year overall survival rate was 94.5%, the 5 year local control rate was 89.3%, and the 5 year relapse-free survival rate (RFSR) was 56.3%. There was an average reduction in renal function of 8.5% after 1 year, and > grade 3 complications occurred in only one case. The RFSR in the patients whose initial stage was T3 was 0%, significantly lower than the 70.4% RFSR in the patients whose initial stage was T1 or T2.

Conclusion: Cryoablation for secondary renal cell carcinoma after nephrectomy was safe and provided good local control with preserved renal function. However, the indications for cryoablation should be carefully considered for patients with T3-stage initial renal cell carcinoma, because of the high risk of relapse.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00270-020-02709-wDOI Listing
March 2021

Projected lung areas using dynamic X-ray (DXR).

Eur J Radiol Open 2020 12;7:100263. Epub 2020 Sep 12.

Japan Anti-Tuberculosis Association, 1-3-12 Kanda-Misakicho, Chiyoda-ku, Tokyo, Japan.

Background: Dynamic X-ray (DXR) provides images of multiple phases of breath with less radiation exposure than CT. The exact images at end-inspiratory or end-expiratory phases can be chosen accurately.

Purpose: To investigate the correlation of the projected lung area (PLA) by dynamic chest X-ray with pulmonary functions.

Material And Methods: One hundred sixty-two healthy volunteers who received medical check-ups for health screening were included in this study. All subjects underwent DXR in both posteroanterior (PA) and lateral views and pulmonary function tests on the same day. All the volunteers took several tidal breaths before one forced breath as instructed. The outlines of lungs were contoured manually on the workstation with reference to the motion of diaphragm and the graph of pixel values. The PLAs were calculated automatically, and correlations with pulmonary functions and demographic data were analyzed statistically.

Results: The PLAs have correlation with physical characteristics, including height, weight and BMI, and pulmonary functions such as vital capacity (VC) and forced expiratory volume in one second (FEV). VC and FEV revealed moderate correlation with the PLAs of PA view in forced inspiratory phase (VC: right, r = 0.65; left, r = 0.69. FEV1: right, r = 0.54; left, r = 0.59). Multivariate analysis showed that body mass index (BMI), sex and VC were considered independent correlation factors, respectively.

Conclusion: PLA showed statistically significant correlation with pulmonary functions. Our results indicate DXR has a possibility to serve as an alternate method for pulmonary function tests in subjects requiring contact inhibition including patients with suspected or confirmed covid-19.
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http://dx.doi.org/10.1016/j.ejro.2020.100263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486627PMC
September 2020

The prognosis and the impact of radiotherapy in clinically regional lymph node-positive prostate cancer: Which patients are candidates for local therapy with radiation?

Urol Oncol 2020 12 6;38(12):931.e1-931.e7. Epub 2020 Sep 6.

Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Background: This study aimed to identify the prognostic and predictive factors of local radiotherapy in clinically regional lymph node-positive prostate cancer.

Patients And Methods: This study includes patients who were newly diagnosed with regional lymph node-positive prostate cancer between 2008 and 2017. We investigated the prognostic value of clinicopathological parameters for progression-free survival (PFS) and overall survival (OS) as well as the differential prognostic impact of radiotherapy by subgroup analysis.

Results: Among the 93 men enrolled as patients, 48 (51.6 %) were treated with radiotherapy. The biopsy positive core rate and biopsy Gleason score were associated with PFS, and the number of lymph node metastases was associated with both PFS and OS. Patients who underwent radiotherapy showed better PFS and OS. High-risk features (at least 2 criteria among ≥75% biopsy positive core rate, Gleason score ≥9, and ≥2 positive lymph nodes) were especially associated with improved outcomes after undergoing radiotherapy.

Conclusion: We identified prognostic factors for clinically regional lymph node-positive prostate cancer and showed the benefits of local radiation therapy. Patients with high-risk features may be especially suitable candidates for radiotherapy.
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http://dx.doi.org/10.1016/j.urolonc.2020.08.018DOI Listing
December 2020

Congenital biliary dilatation in the era of laparoscopic surgery, focusing on the high incidence of anatomical variations of the right hepatic artery.

J Hepatobiliary Pancreat Sci 2020 Nov 19;27(11):870-876. Epub 2020 Sep 19.

Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Background: The present study aimed to evaluate anatomical variations of the right hepatic artery (RHA) in patients with congenital biliary dilatation (CBD) and the appropriate approach in laparoscopic surgery for CBD.

Methods: The medical records of 36 patients who underwent laparoscopic or open surgery for CBD from 1996 to 2018 were retrospectively reviewed. Radiological evaluation of the origin and course of the RHA in these 36 patients were compared with 195 control patients without CBD.

Results: The incidence of the RHA crossing anterior to the common hepatic duct (CHD) was significantly higher in patients with CBD than in those without CBD (33% versus 10%, P = .0001). There was no intraoperative injury of the RHA, irrespective of the course of the RHA. The CHD was divided at the caudal side of the RHA in 11 of 12 patients (92%) with the anterior type of RHA, and in 13 of 24 patients (54%) with the posterior type of RHA (P = .03).

Conclusions: Patients with CBD had a higher incidence of the RHA crossing anterior to the CHD than patients without CBD. Preservation of the RHA in each situation is necessary during surgery for CBD in the era of laparoscopic surgery.
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http://dx.doi.org/10.1002/jhbp.819DOI Listing
November 2020

Correction to: Computed tomography surveillance helps tracking COVID‑19 outbreak.

Jpn J Radiol 2020 Dec;38(12):1177-1178

Department of Radiology, Tokai University Hachioji Hospital, 1838 Ishikawa-cho, Hachioji City, Tokyo, 192-0032, Japan.

The original article can be found online.
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http://dx.doi.org/10.1007/s11604-020-01033-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450039PMC
December 2020

Computed tomography surveillance helps tracking COVID-19 outbreak.

Jpn J Radiol 2020 Dec 7;38(12):1169-1176. Epub 2020 Aug 7.

Department of Radiology, Tokai University Hachioji Hospital, 1838 Ishikawa-cho, Hachioji City, Tokyo, 192-0032, Japan.

Purpose: To reveal that a computed tomography surveillance program (CT-surveillance) could demonstrate the epidemiologic features of COVID-19 infection and simultaneously investigate the type and frequency of CT findings using clinical CT data.

Materials And Methods: We targeted individuals with possible CT findings of viral pneumonia. Using an online questionnaire, we asked Japanese board-certified radiologists to register their patients' information including patient age and sex, the CT examination date, the results of PCR test for COVID-19 infection, CT findings, and the postal code of the medical institution that performed the CT. We compared the diurnal patient number and the cumulative regional distribution map of registrations in CT-surveillance to those of the PCR-positive patient surveillance (PCR-surveillance).

Results: A total of 637 patients was registered from January 1 to April 17, 2020 for CT-surveillance. Their PCR test results were positive (n = 62.5-398%), negative (n = 8.9-57%), unknown (n = 26.2-167%), and other disease (n = 2.4-15%). An age peak at 60-69 years and male dominance were observed in CT-surveillance. The most common CT finding was bilaterally distributed ground-glass opacities. The diurnal number and the cumulative regional distribution map by CT-surveillance showed tendencies that were similar to those revealed by PCR-surveillance.

Conclusion: Using clinical CT data, CT-surveillance program delineated the epidemiologic features of COVID-19 infection.
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http://dx.doi.org/10.1007/s11604-020-01026-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410527PMC
December 2020

Pulmonary ventilation-perfusion mismatch demonstrated by dynamic chest radiography in giant cell arteritis.

Eur Heart J 2021 01;42(2):208-209

Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.

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http://dx.doi.org/10.1093/eurheartj/ehaa443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813626PMC
January 2021

Risk factors of recurrence after postoperative electron beam radiation therapy for keloid: Comparison of long-term local control rate.

Rep Pract Oncol Radiother 2020 Jul-Aug;25(4):606-611. Epub 2020 May 19.

Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan.

Aim: To investigate the new risk factors for keloid recurrence after postoperative electron beam radiotherapy (RT) and evaluate the effectiveness of tranilast in combination with electron beam RT by comparing the local control rate.

Background: Identifying patients at high risk of recurrence after postoperative RT for keloids remains a challenge. Besides, no study examined the effectiveness of tranilast in combination with RT after surgery for the prevention of keloids recurrence.

Materials And Methods: This study included 75 lesions in 59 consecutive patients who had undergone postoperative RT at our institute. The follow-up period and prescription of tranilast were examined beside several potential risk factors, such as multiple lesions, size, and shape.

Results: The median follow-up was 72 months (range, 6-147 months). Twenty-one lesions in 17 patients recurred in a median of 12 months after treatment (range, 1-60 months). Local control rates of all 75 lesions were estimated as 93%, 78%, 70%, and 68% at 1, 2, 5, and 10 years. Multiple lesions constituted a significant risk of recurrence (P = 0.03). A larger long axis was significantly related to the recurrence (P < 0.01). Irregular shape was associated with a significantly worse local control rate (P = 0.02). There was no significant difference in the local control rate between patients receiving tranilast and those who did not (P = 0.52).

Conclusions: Multiple lesions and irregular shape were risk factors of keloid recurrence after postoperative electron beam RT. The effectiveness of tranilast was not demonstrated in the study.
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http://dx.doi.org/10.1016/j.rpor.2020.05.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270504PMC
May 2020

CT radiomics analysis of lung cancers: Differentiation of squamous cell carcinoma from adenocarcinoma, a correlative study with FDG uptake.

Eur J Radiol 2020 Jul 26;128:109032. Epub 2020 Apr 26.

Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan. Electronic address:

Background And Purpose: Pulmonary squamous cell carcinoma (SCC) was reported to have significantly higher histogram_kurtosis obtained by unenhanced computed tomography (CT) and a greater maximum standardized uptake value (SUVmax) determined by F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG-PET/CT) than pulmonary adenocarcinoma (AD). The first study aim was to investigate whether CT radiomics features could differentiate SCC from AD. The second aim was to investigate correlations between CT radiomics features and SUVmax.

Materials And Methods: Forty solid lung tumors < 3 cm in diameter pathologically proven to be SCC (n = 18) or AD (n = 22) were included. The SUVmax was determined by F-FDG-PET/CT and 42 CT radiomics features were obtained from unenhanced CT. A Mann-Whitney U test was used to compare the SUVmax and each CT radiomics feature to differentiate SCC from AD. The area under the curve (AUC) was calculated from receiver operating characteristic (ROC) analysis. A binary logistic regression analysis was performed for a combination of SUVmax with each CT radiomics feature. A Spearman rank correlation analysis was performed to determine correlations between SUVmax and CT radiomics features.

Results: Twenty-six of 42 CT radiomics features were significantly different between groups. The best AUC of the CT radiomics features was 0.81 for both the GLRLM_SRHGE and GLZLM_HGZE. The AUC value improved when the shape_sphericity feature was combined with SUVmax (AUC = 0.92). The CT radiomics features exhibiting strongest correlations with the SUVmax were different in both AD and SCC groups.

Conclusion: CT radiomics features correlated with tumor structural characteristics of SCC and AD, and were closely related to metabolic information from FDG-PET/CT.
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http://dx.doi.org/10.1016/j.ejrad.2020.109032DOI Listing
July 2020
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