Faculty Profiles - NAGANAWA, Shinji

Papers - NAGANAWA, Shinji

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Evaluation of magnetic resonance angiography as a possible alternative to rotational angiography or computed tomography angiography for assessing cerebrovascular computational fluid dynamics. Reviewed International journal

Yuya Yoneyama, Haruo Isoda, Kenta Ishiguro, Masaki Terada, Masaki Kamiya, Kenichi Otsubo, Roshani Perera, Takashi Mizuno, Atsushi Fukuyama, Kazuya Takiguchi, Tomoya Watanabe, Takafumi Kosugi, Yoshiaki Komori, Shinji Naganawa

Physical and engineering sciences in medicine Vol. 43 ( 4 ) page： 1327 - 1337 2020.12

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

The aim of this study was to conduct a flow experiment using a cerebrovascular phantom and investigate whether magnetic resonance angiography (MRA) could replace three-dimensional rotational angiography (RA) and computed tomography angiography (CTA) to construct vascular models for computational fluid dynamics (CFD). We performed MRA and 3D cine phase-contrast (PC) MR imaging with a silicone cerebrovascular phantom of an internal carotid artery-posterior communicating artery aneurysm with blood-mimicking fluid, and controlled flow with a flowmeter. We also obtained RA and CTA data for the phantom. Four analysts constructed vascular models based on the three different modalities. These 12 constructed models used flow information based on 3D cine PC MR imaging for CFD. We compared RA-, CTA-, MRA-based CFD results using the micro-CT-based CFD result as the criterion standard to investigate whether MRA-based CFD was not inferior to RA- or CTA-based CFD. We also analyzed the inter-analyst variability. Wall shear stress (WSS) distributions and streamlines of RA- or MRA-based CFD and those of micro-CT-based CFD were similar, but the vascular models and WSS values were different. Accuracy in measurements of blood vessel diameter, cross-sectional maximum velocity, and spatially averaged WSS was the highest for RA-based CFD, followed by MRA-based and CTA-based CFD using micro-CT-based CFD result as the reference. Except maximum velocity from CTA, all other parameters had good inter-analyst agreement using different modalities. The results demonstrated that non-invasive MRA can be used for cerebrovascular CFD models with good inter-analyst agreements.

DOI： 10.1007/s13246-020-00936-6

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PubMed

【基調論文】CTおよびMRIなどの画像診断装置の今後の展望 Reviewed

長縄慎二

月間新医療データブック・シリーズ　医療機器システム白書 Vol. - ( - ) page： 14 - 18 2020.12

【特集】　マネジメントに苦慮する疾患： Is it benign, malignant or insignificant? 1. 甲状腺病変の診断とマネジメント Invited Reviewed

石垣聡子、佐竹弘子、松本篤子、林　葉子、清水友理、長縄慎二

日獨医報 Vol. 65 ( 1 ) page： 5 - 11 2020.12

Identifying the brain's connector hubs at the voxel level using functional connectivity overlap ratio. Reviewed International journal

Epifanio Bagarinao, Hirohisa Watanabe, Satoshi Maesawa, Daisuke Mori, Kazuhiro Hara, Kazuya Kawabata, Reiko Ohdake, Michihito Masuda, Aya Ogura, Toshiyasu Kato, Shuji Koyama, Masahisa Katsuno, Toshihiko Wakabayashi, Masafumi Kuzuya, Minoru Hoshiyama, Haruo Isoda, Shinji Naganawa, Norio Ozaki, Gen Sobue

NeuroImage Vol. 222 page： 117241 - 117241 2020.11

Language：English Publishing type：Research paper (scientific journal)

Neuroimaging studies have shown that the brain is functionally organized into several large-scale brain networks. Within these networks are regions that are widely connected to several other regions within and/or outside the network. Regions that connect to several other networks, known as connector hubs, are believed to be crucial for information transfer and between-network communication within the brain. To identify regions with high between-network connectivity at the voxel level, we introduced a novel metric called functional connectivity overlap ratio (FCOR), which quantifies the spatial extent of a region's connection to a given network. Using resting state functional magnetic resonance imaging data, FCOR maps were generated for several well-known large-scale resting state networks (RSNs) and used to examine the relevant associations among different RSNs, identify connector hub regions in the cerebral cortex, and elucidate the hierarchical functional organization of the brain. Constructed FCOR maps revealed a strong association among the core neurocognitive networks (default mode, salience, and executive control) as well as among primary processing networks (sensorimotor, auditory, and visual). Prominent connector hubs were identified in the bilateral middle frontal gyrus, posterior cingulate, lateral parietal, middle temporal, dorsal anterior cingulate, and anterior insula, among others, regions mostly associated with the core neurocognitive networks. Finally, clustering the whole brain using FCOR features yielded a topological organization that arranges brain regions into a hierarchy of information processing systems with the primary processing systems at one end and the heteromodal systems comprising connector hubs at the other end.

DOI： 10.1016/j.neuroimage.2020.117241

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Neurofluid Dynamics and the Glymphatic System: A Neuroimaging Perspective. Reviewed International journal

Toshiaki Taoka, Shinji Naganawa

Korean journal of radiology Vol. 21 ( 11 ) page： 1199 - 1209 2020.11

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

The glymphatic system hypothesis is a concept describing the clearance of waste products from the brain. The term "glymphatic system" combines the glial and lymphatic systems and is typically described as follows. The perivascular space functions as a conduit that drains cerebrospinal fluid (CSF) into the brain parenchyma. CSF guided to the perivascular space around the arteries enters the interstitium of brain tissue via aquaporin-4 water channels to clear waste proteins into the perivascular space around the veins before being drained from the brain. In this review, we introduce the glymphatic system hypothesis and its association with fluid dynamics, sleep, and disease. We also discuss imaging methods to evaluate the glymphatic system.

DOI： 10.3348/kjr.2020.0042

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Aging Impacts the Overall Connectivity Strength of Regions Critical for Information Transfer Among Brain Networks Reviewed International journal Open Access

Epifanio Bagarinao, Hirohisa Watanabe, Satoshi Maesawa, Daisuke Mori, Kazuhiro Hara, Kazuya Kawabata, Noritaka Yoneyama, Reiko Ohdake, Kazunori Imai, Michihito Masuda, Takamasa Yokoi, Aya Ogura, Toshiaki Taoka, Shuji Koyama, Hiroki C. Tanabe, Masahisa Katsuno, Toshihiko Wakabayashi, Masafumi Kuzuya, Minoru Hoshiyama, Haruo Isoda, Shinji Naganawa, Norio Ozaki, Gen Sobue

Frontiers in Aging Neuroscience Vol. 12 page： 592469 - 592469 2020.10

Language：English Publishing type：Research paper (scientific journal) Publisher：Frontiers Media SA

Recent studies have demonstrated that connector hubs, regions considered critical for the flow of information across neural systems, are mostly involved in neurodegenerative dementia. Considering that aging can significantly affect the brain's intrinsic connectivity, identifying aging's impact on these regions' overall connection strength is important to differentiate changes associated with healthy aging from neurodegenerative disorders. Using resting state functional magnetic resonance imaging data from a carefully selected cohort of 175 healthy volunteers aging from 21 to 86 years old, we computed an intrinsic connectivity contrast (ICC) metric, which quantifies a region's overall connectivity strength, for whole brain, short-range, and long-range connections and examined age-related changes of this metric over the adult lifespan. We have identified a limited number of hub regions with ICC values that showed significant negative relationship with age. These include the medial precentral/midcingulate gyri and insula with both their short-range and long-range (and thus whole-brain) ICC values negatively associated with age, and the angular, middle frontal, and posterior cingulate gyri with their long-range ICC values mainly involved. Seed-based connectivity analyses further confirmed that these regions are connector hubs with connectivity profile that strongly overlapped with multiple large-scale brain networks. General cognitive performance was not associated with these hubs' ICC values. These findings suggest that even healthy aging could negatively impact the efficiency of regions critical for facilitating information transfer among different functional brain networks. The extent of the regions involved, however, was limited.

DOI： 10.3389/fnagi.2020.592469

Open Access

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Significance of high signal intensity in the endolymphatic duct on magnetic resonance imaging in ears with otological disorders. Reviewed International journal

Kyoko Morimoto, Tadao Yoshida, Masumi Kobayashi, Satofumi Sugimoto, Naoki Nishio, Masaaki Teranishi, Shinji Naganawa, Michihiko Sone

Acta oto-laryngologica Vol. 140 ( 10 ) page： 818 - 822 2020.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: High signal intensity in the endolymphatic duct (ED) is occasionally observed on magnetic resonance imaging (MRI) in ears that have otological disorders. OBJECTIVE: The signal intensity (SI) in the ED on post-contrast MRI was investigated in subjects with various otological disorders, and the meaning of high SI in the ED was evaluated. MATERIAL AND METHODS: 392 patients with otological disorders and 21 controls without otological symptoms underwent 3 T MRI. The SIs of the ED and the cerebellum were measured, the SI ratio (SIR) was calculated, and ears with SIR ≥4 were identified. RESULTS: A high SIR was identified in the ED of 3.7% of ears affected by definite Meniere's disease (dMD), 100% of ears affected by large vestibular aqueduct syndrome (LVAS), and 7.1% of ears with no otological symptoms. On the whole, a significant relationship was found between the existence of vestibular or cochlear EH and the SIR in the ED. CONCLUSION: The MRI finding of high SI in the ED may indicate the mechanism of inner ear disturbances in ears with otological disorders, especially in those with LVAS, and it may suggest an underlying disorder in some ears in which otological symptoms are not apparent.

DOI： 10.1080/00016489.2020.1781927

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Change of White Matter Integrity in Children With Hematopoietic Stem Cell Transplantation. Reviewed International journal

Yoko Sakaguchi, Jun Natsume, Hiroyuki Kidokoro, Masaharu Tanaka, Yu Okai, Yuji Ito, Hiroyuki Yamamoto, Atsuko Ohno, Tomohiko Nakata, Toshiki Nakane, Hisashi Kawai, Toshiaki Taoka, Hideki Muramatsu, Shinji Naganawa, Yoshiyuki Takahashi

Pediatric neurology Vol. 111 page： 78 - 84 2020.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Advances in hematopoietic stem cell transplantation have improved the survival rate of malignant diseases and congenital immunodeficiencies. It has become important to assess long-term complications in survivors. To assess neurological abnormalities in children treated by transplantation, diffusion tensor imaging was performed. METHODS: Forty children who underwent head diffusion tensor imaging before and after their first transplantation were enrolled. Patients with brain lesions on conventional MRI were excluded. Fractional anisotropy and mean diffusivity were compared between patients and 28 control subjects using tract-based spatial statistics. The Strengths and Difficulties Questionnaire was administered as a behavioral evaluation after transplantation, and diffusion tensor images of patients with and without behavioral abnormalities were compared. RESULTS: The age of patients and controls was 0 to 19 years and 0 to 16 years, respectively. The date of diffusion tensor imaging was 10 to 57 days before and 40 to 153 days after transplantation. Tract-based spatial statistics showed fractional anisotropy reduction in widespread white matter in patients before and after transplantation. Mean diffusivity was high before transplantation and normalized after transplantation. Analysis comparing before and after hematopoietic stem cell transplantation shows no difference in fractional anisotropy and a higher mean diffusivity before hematopoietic stem cell transplantation. In patients with behavioral abnormalities, low fractional anisotropy and high mean diffusivity remained after transplantation. CONCLUSIONS: Longitudinal diffusion tensor imaging showed white matter abnormalities in children without conventional MRI abnormalities, which were related to behavioral problems after transplantation. Diffusion tensor imaging is useful for behavioral assessment in children undergoing transplantation.

DOI： 10.1016/j.pediatrneurol.2020.06.008

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A review on the use of artificial intelligence for medical imaging of the lungs of patients with coronavirus disease 2019. Reviewed International journal

Rintaro Ito, Shingo Iwano, Shinji Naganawa

Diagnostic and interventional radiology (Ankara, Turkey) Vol. 26 ( 5 ) page： 443 - 448 2020.9

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

The results of research on the use of artificial intelligence (AI) for medical imaging of the lungs of patients with coronavirus disease 2019 (COVID-19) has been published in various forms. In this study, we reviewed the AI for diagnostic imaging of COVID-19 pneumonia. PubMed, arXiv, medRxiv, and Google scholar were used to search for AI studies. There were 15 studies of COVID-19 that used AI for medical imaging. Of these, 11 studies used AI for computed tomography (CT) and 4 used AI for chest radiography. Eight studies presented independent test data, 5 used disclosed data, and 4 disclosed the AI source codes. The number of datasets ranged from 106 to 5941, with sensitivities ranging from 0.67-1.00 and specificities ranging from 0.81-1.00 for prediction of COVID-19 pneumonia. Four studies with independent test datasets showed a breakdown of the data ratio and reported prediction of COVID-19 pneumonia with sensitivity, specificity, and area under the curve (AUC). These 4 studies showed very high sensitivity, specificity, and AUC, in the range of 0.9-0.98, 0.91-0.96, and 0.96-0.99, respectively.

DOI： 10.5152/dir.2019.20294

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第21回山形めまい研究会　特別講演Ⅰ　MR imaging of endolymphatic hydrops; What is right, what is wrong, and what is new Invited Reviewed

長縄慎二

耳鼻咽喉科山形 (日本耳鼻咽喉科学会山形県地方部会誌) Vol. 24 ( - ) page： 54 - 55 2020.9

Changes in white matter fiber density and morphology across the adult lifespan: A cross-sectional fixel-based analysis. Reviewed International journal

Shao Wei Choy, Epifanio Bagarinao, Hirohisa Watanabe, Eric Tatt Wei Ho, Satoshi Maesawa, Daisuke Mori, Kazuhiro Hara, Kazuya Kawabata, Noritaka Yoneyama, Reiko Ohdake, Kazunori Imai, Michihito Masuda, Takamasa Yokoi, Aya Ogura, Toshiaki Taoka, Shuji Koyama, Hiroki C Tanabe, Masahisa Katsuno, Toshihiko Wakabayashi, Masafumi Kuzuya, Minoru Hoshiyama, Haruo Isoda, Shinji Naganawa, Norio Ozaki, Gen Sobue

Human brain mapping Vol. 41 ( 12 ) page： 3198 - 3211 2020.8

Language：English Publishing type：Research paper (scientific journal)

White matter (WM) fiber bundles change dynamically with age. These changes could be driven by alterations in axonal diameter, axonal density, and myelin content. In this study, we applied a novel fixel-based analysis (FBA) framework to examine these changes throughout the adult lifespan. Using diffusion-weighted images from a cohort of 293 healthy volunteers (89 males/204 females) from ages 21 to 86 years old, we performed FBA to analyze age-related changes in microscopic fiber density (FD) and macroscopic fiber morphology (fiber cross section [FC]). Our results showed significant and widespread age-related alterations in FD and FC across the whole brain. Interestingly, some fiber bundles such as the anterior thalamic radiation, corpus callosum, and superior longitudinal fasciculus only showed significant negative relationship with age in FD values, but not in FC. On the other hand, some segments of the cerebello-thalamo-cortical pathway only showed significant negative relationship with age in FC, but not in FD. Analysis at the tract-level also showed that major fiber tract groups predominantly distributed in the frontal lobe (cingulum, forceps minor) exhibited greater vulnerability to the aging process than the others. Differences in FC and the combined measure of FD and cross section values observed between sexes were mostly driven by differences in brain sizes although male participants tended to exhibit steeper negative linear relationship with age in FD as compared to female participants. Overall, these findings provide further insights into the structural changes the brain's WM undergoes due to the aging process.

DOI： 10.1002/hbm.25008

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Efficacy and safety of accelerated fractionated radiotherapy without elective nodal irradiation for T3N0 glottic cancer without vocal cord fixation. Reviewed International journal

Masayuki Okumura, Atsushi Motegi, Sadamoto Zenda, Naoki Nakamura, Hidehiro Hojo, Masaki Nakamura, Yasuhiro Hirano, Shun-Ichiro Kageyama, Satoko Arahira, Raturi Vijay Parshuram, Hirofumi Kuno, Ryuichi Hayashi, Makoto Tahara, Yoshiyuki Itoh, Shinji Naganawa, Tetsuo Akimoto

Head & neck Vol. 42 ( 8 ) page： 1775 - 1782 2020.8

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The purpose of this study was to evaluate accelerated fractionated radiotherapy (AFRT) without elective nodal irradiation (ENI) for T3N0 glottic cancer (GC) without vocal cord fixation, especially in comparison with chemoradiotherapy (CRT) and hyperfractionated radiotherapy (HFRT) both of which included ENI. METHODS: The medical charts of patients with T3N0GC without cord fixation received definitive radiotherapy between June 2005 and March 2018 were reviewed. RESULTS: A total of 74 patients were analyzed. After a median follow-up time of 46 months (range, 12-141), 3-year local failure in AFRT/CRT/HFRT (n = 41/10/23) was 10%/20%/26%, 3-year regional failure 6%/0%/9%, 3-year progression-free survival 71%/69%/74%, and 3-year overall survival 77%/100%/87%. There were no significant differences among three groups in recurrence or survival. Grade 3 adverse events (AEs) were noted in 5/2/8 patients (12%/20%/35%) in AFRT/CRT/HFRT, respectively. There were no Grade 4/5 AEs. CONCLUSIONS: AFRT without ENI is an effective and feasible treatment for T3N0GC without cord fixation.

DOI： 10.1002/hed.26092

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PubMed

ロボット支援前立腺全摘除術後の難治性乳び腹水に対してリンパ管塞栓術が奏功した一例 Reviewed

兵藤良太, 山田恵一郎, 堀口瞭太, 伊藤準, 松島正哉, 駒田智大, 大脇貴之, 竹原康雄, 長縄慎二

日本インターベンショナルラジオロジー学会雑誌 Vol. 35 ( Suppl. ) page： 290 - 290 2020.8

Effects of endolymphatic hydrops on acoustic energy absorbance. Reviewed International journal

Masumi Kobayashi, Tadao Yoshida, Satofumi Sugimoto, Mariko Shimono, Masaaki Teranishi, Shinji Naganawa, Michihiko Sone

Acta oto-laryngologica Vol. 140 ( 8 ) page： 626 - 631 2020.7

Language：English Publishing type：Research paper (scientific journal)

Background: The presence of endolymphatic hydrops (EH) may cause hearing loss and affect the transmission of acoustic energy to the inner ear.Objectives: Acoustic energy absorbance on wideband acoustic immittance (WAI) was evaluated, focusing especially on EH in the vestibule.Material and methods: A total of 32 ears from 16 patients who underwent 3-T magnetic resonance imaging (MRI) to evaluate the presence of EH were examined, retrospectively. The degree of EH in the vestibule was classified into three grades (no, mild, and significant), and pure tone audiometry (PTA) and WAI were measured before and after a glycerol drip.Results: Ears with significant EH showed significantly higher hearing levels and air-bone gaps (ABG), and higher absorbance values on WAI at low frequencies (560-600 Hz) than ears with mild or no EH. Changes in absorbance values were observed in some ears without threshold change on PTA.Conclusions and Significance: This study showed significantly higher absorbance values of acoustic energy with significant vestibular EH at low frequencies. Considering ABGs observed in ears with significant EH, the presence of EH in the vestibule might cause an obstacle to the transmission of acoustic energy to the inner ear.

DOI： 10.1080/00016489.2020.1754460

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A phase I/II trial of intraoperative breast radiotherapy in an Asian population: 10-year results with critical evaluation. Reviewed International journal

Mariko Kawamura, Yoshiyuki Itoh, Takeshi Kamomae, Masataka Sawaki, Toyone Kikumori, Nobuyuki Tsunoda, Junji Ito, Yoshie Shimoyama, Hiroko Satake, Shinji Naganawa

Journal of radiation research Vol. 61 ( 4 ) page： 602 - 607 2020.7

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

Although phase III trials have been published comparing whole breast irradiation (WBI) with accelerated partial breast irradiation (APBI) using intraoperative radiotherapy (IORT), long-term follow-up results are lacking. We report the 10-year follow-up results of a prospective phase I/II clinical trial of IORT. The inclusion criteria were as follows: (i) tumor size <2.5 cm, (ii) desire for breast-conserving surgery, (iii) age >50 years, (iv) negative margins after resection and (v) sentinel lymph node-negative disease. A single dose of IORT (19-21 Gy) was delivered to the tumor bed in the operation room just after wide local excision of the primary breast cancer using a 6-12 MeV electron beam. Local recurrence was defined as recurrence or new disease within the treated breast and was evaluated annually using mammography and ultrasonography. A total of 32 patients were eligible for evaluation. The median patient age was 65 years and the median follow-up time was 10 years. Two patients experienced local recurrence just under the nipple, out of the irradiated field, after 8 years of follow-up. Three patients had contralateral breast cancer and one patient experienced bone metastasis after 10 years of follow-up. No patient experienced in-field recurrence nor breast cancer death. Eight patients had hypertrophic scarring at the last follow-up. There were no lung or heart adverse effects. This is the first report of 10-year follow-up results of IORT as APBI. The findings suggest that breast cancer with extended intraductal components should be treated with great caution.

DOI： 10.1093/jrr/rraa029

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Evaluation of segment 4 portal vein embolization added to right portal vein for right hepatic trisectionectomy: a retrospective propensity score-matched study. Reviewed

Jun Ito, Tomohiro Komada, Kojiro Suzuki, Masaya Matsushima, Masahiro Nakatochi, Yumiko Kobayashi, Tomoki Ebata, Shinji Naganawa, Masato Nagino

Journal of hepato-biliary-pancreatic sciences Vol. 27 ( 6 ) page： 299 - 306 2020.6

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Adding segment 4 (S4) portal vein embolization (PVE) to right PVE before right hepatic trisectionectomy is controversial. We retrospectively examined the effect of S4 PVE on segments 2 and 3 (S2+3) hypertrophy. METHODS: We reviewed patients with biliary carcinoma who underwent right PVE with (R3PVE) or without (R2PVE) S4 PVE using gelatin sponge particles and coils (2010-2019). Propensity score matching balanced the cohort for baseline characteristics, including total liver volume and S2+3 volume before PVE. We compared the groups regarding the S2+3 volume changes after PVE. RESULTS: Of 178 enrolled patients, 38 underwent R3PVE for right hepatic trisectionectomy and 140 underwent R2PVE for right hepatectomy. Twenty-eight patients from each group were respectively matched. The median absolute volume increase in (146 cm3 vs 70 cm3 ), hypertrophy rate of (52.4% vs 32.3%), and kinetic growth rate of (3.1 %/week vs 2.0 %/week) S2+3 were significantly higher in the R3PVE group than in the R2PVE group. In the pre-matched cohort, the rate of posthepatectomy liver failure and postoperative hospital stay did not significantly differ between the patients who underwent right hepatic trisectionectomy and right hepatectomy. CONCLUSION: R3PVE increased the S2+3 volume more effectively than R2PVE in patients with biliary carcinoma.

DOI： 10.1002/jhbp.723

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Unexpected radioactive iodine accumulation on whole-body scan after I-131 ablation therapy for differentiated thyroid cancer. Reviewed

Shingo Iwano, Shinji Ito, Shinichiro Kamiya, Rintaro Ito, Katsuhiko Kato, Shinji Naganawa

Nagoya journal of medical science Vol. 82 ( 2 ) page： 205 - 215 2020.5

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

We retrospectively evaluated the frequency of unexpected accumulation of radioactive iodine on the post-therapy whole-body scan (Rx-WBS) after radioactive iodine (RAI) ablation therapy in patients with differentiated thyroid cancer (DTC). We searched our institutional database for Rx-WBSs of DTC patients who underwent RAI ablation or adjuvant therapy between 2012 and 2019. Patients with distant metastasis diagnosed by CT or PET/CT before therapy, and those had previously received RAI therapy were excluded. In total, 293 patients (201 female and 92 male, median age 54 years) were selected. Two nuclear medicine physicians interpreted the Rx-WBS images by determining the visual intensity of radioiodine uptake by the thyroid bed, cervical and mediastinal lymph nodes, lungs, and bone. Clinical features of the patients with and without the metastatic accumulation were compared by chi-square test and median test. Logistic regression analyses were performed to compare the association between the presence of metastatic accumulation and these clinical factors. Eighty-four of 293 patients (28.7%) showed metastatic accumulation. Patients with metastatic RAI accumulation showed a significantly higher frequency of pathological N1 (pN1) and serum thyroglobulin (Tg) > 1.5 ng/ml under TSH stimulation (p = 0.035 and p = 0.031, respectively). Logistic regression analysis indicated that a serum Tg > 1.5 ng/ml was significantly correlated with the presence of metastatic accumulation (odds ratio = 1.985; p = 0.033). In conclusion, Patients with Tg > 1.5 ng/ml were more likely to show metastatic accumulation. In addition, the presence of lymph node metastasis at the initial thyroid surgery was also associated with this unexpected metastatic accumulation.

DOI： 10.18999/nagjms.82.2.205

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特集　基礎から学ぶ肺癌診断　　肺癌の3次元CT・PET/CT診断―原発巣の診断と悪性度― Reviewed

岩野信吾、伊藤信嗣、伊藤倫太郎、神谷晋一朗、加藤克彦、長縄慎二

画像診断 Vol. 40 ( 5 ) page： 439 - 446 2020.5

150周年記念記事　高次医用科学　創基150周年に寄せて Reviewed

長縄慎二

名大医学部学友時報 Vol. 843 ( - ) page： 10 - 10 2020.4

Evaluation of newly implemented dose calculation algorithms for multileaf collimator-based CyberKnife tumor-tracking radiotherapy. Reviewed International journal

Kohei Kawata, Takeshi Kamomae, Hiroshi Oguchi, Fumitaka Kawabata, Kuniyasu Okudaira, Mariko Kawamura, Kazuhiro Ohtakara, Yoshiyuki Itoh, Shinji Naganawa

Medical physics Vol. 47 ( 3 ) page： 1391 - 1403 2020.3

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

PURPOSE: In the previous treatment planning system (TPS) for CyberKnife (CK), multileaf collimator (MLC)-based treatment plans could be created only by using the finite-size pencil beam (FSPB) algorithm. Recently, a new TPS, including the FSPB with lateral scaling option (FSPB+) and Monte Carlo (MC) algorithms, was developed. In this study, we performed basic and clinical end-to-end evaluations for MLC-based CK tumor-tracking radiotherapy using the MC, FSPB+, and FSPB. METHODS: Water- and lung-equivalent slab phantoms were combined to obtain the percentage depth dose (PDD) and off-center ratio (OCR). The CK M6 system and Precision TPS were employed, and PDDs and OCRs calculated by the MC, FSPB+, and FSPB were compared with the measured doses obtained for 30.8 × 30.8 mm2 and 60.0 × 61.6 mm2 fields. A lung motion phantom was used for clinical evaluation and MLC-based treatment plans were created using the MC. The doses were subsequently recalculated using the FSPB+ and FSPB, while maintaining the irradiation parameters. The calculated doses were compared with the doses measured using a microchamber (for target doses) or a radiochromic film (for dose profiles). The dose volume histogram (DVH) indices were compared for all plans. RESULTS: In homogeneous and inhomogeneous phantom geometries, the PDDs calculated by the MC and FSPB+ agreed with the measurements within ±2.0% for the region between the surface and a depth of 250 mm, whereas the doses calculated by the FSPB in the lung-equivalent phantom region were noticeably higher than the measurements, and the maximum dose differences were 6.1% and 4.4% for the 30.8 × 30.8 mm2 and 60.0 × 61.6 mm2 fields, respectively. The maximum distance to agreement values of the MC, FSPB+, and FSPB at the penumbra regions of OCRs were 1.0, 0.6, and 1.1 mm, respectively, but the best agreement was obtained between the MC-calculated curve and measurements at the boundary of the water- and lung-equivalent slabs, compared with those of the FSPB+ and FSPB. For clinical evaluations using the lung motion phantom, under the static motion condition, the dose errors measured by the microchamber were -1.0%, -1.9%, and 8.8% for MC, FSPB+, and FSPB, respectively; their gamma pass rates for the 3%/2 mm criterion comparing to film measurement were 98.4%, 87.6%, and 31.4% respectively. Under respiratory motion conditions, there was no noticeable decline in the gamma pass rates. In the DVH indices, for most of the gross tumor volume and planning target volume, significant differences were observed between the MC and FSPB, and between the FSPB+ and FSPB. Furthermore, significant differences were observed for lung Dmean , V15 Gy , and V20 Gy between the MC, FSPB+, and FSPB. CONCLUSIONS: The results indicate that the doses calculated using the MC and FSPB+ differed remarkably in inhomogeneous regions, compared with the FSPB. Because the MC was the most consistent with the measurements, it is recommended for final dose calculations in inhomogeneous regions such as the lung. Furthermore, the sufficient accuracy of dose delivery using MLC-based tumor-tracking radiotherapy by CK was demonstrated for clinical implementation.

DOI： 10.1002/mp.14013

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Papers - NAGANAWA, Shinji