Faculty Profiles - SATAKE, Hiroko

Papers - SATAKE, Hiroko

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Assessment of the pancreatic and intrapancreatic bile ducts using 0.5-mm collimation and multiplanar reformatted images in multislice CT.

Itoh S, Ikeda M, Ota T, Satake H, Takai K, Ishigaki T

Eur Radiol Vol. 13 page： 277-285 2003

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

Our objective was to evaluate the ability of multiplanar reformatted (MPR) images combined with 0.5-mm axial images to depict the pancreatic and intrapancreatic bile ducts and compare the results with those of 0.5-mm axial, 2-mm axial, and 6-mm axial images alone. Seventy-seven patients without obstruction of the main pancreatic ducts (MPD) underwent dual-phase helical scanning of the pancreas using multislice computed tomography (MSCT). The MPR images were generated from 0.5-mm-thick images. Visualization of the pancreatic and intrapancreatic bile ducts and their confluence was graded on a four-point scale by a consensus of two radiologists. The results for 0.5-mm axial images in early-phase CT, 2-mm axial images in early-phase CT, MPR images combined with 0.5-mm axial images in early-phase CT, and 6-mm axial images in late-phase CT were then compared. The relationships of the focal pancreatic lesions with the pancreatic ducts were analyzed. The MPR images combined with 0.5-mm axial images were significantly superior to the other three types of images for the visualization of the pancreatic and intrapancreatic bile ducts and their confluence (p<0.01). The depiction rate of the MPD using MPR images combined with 0.5-mm axial images was 94, 94, 95, and 75%, respectively in the head, neck, body, and tail of the pancreas. Accessory pancreatic ducts, intrapancreatic bile ducts, and duct confluence were depicted in 48, 99, and 92%, respectively. In comparison with evaluation based on axial images alone, the use of MPR images more clearly demonstrated the relationship between the lesions and the pancreatic ducts in 14 of 19 lesions. The MPR images combined with 0.5-mm axial images improve the CT depiction of the pancreatic and intrapancreatic bile ducts in comparison with 0.5-mm axial, 2-mm axial, and 6-mm axial images alone.

Multiphase contrast-enhanced CT of the liver with a multislice CT scanner.

Itoh S, Ikeda M, Achiwa M, Ota T, Satake H, Ishigaki T

Eur Radiol Vol. 13 page： 1085-1094 2003

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

Our objective was to assess the effects of the injection rate of contrast material and of a 5% dextrose flush on enhancement in multiphase hepatic CT using a multislice CT scanner. Most patients had chronic hepatitis and/or liver cirrhosis. One hundred eighty examinations, in which two sequential acquisitions were performed during a single breath-hold followed by third- and fourth-pass acquisitions, were randomized into four protocols: contrast injection at 0.1 ml/kg body weight s(-1) over 21 s without and with a 30-ml flush in groups 1 and 2, respectively, and contrast injection at 0.07 ml/kg body weight s(-1) over 30 s without and with a flush in groups 3 and 4, respectively. Contrast enhancement in each acquisition was measured in the aorta, portal vein, and liver. The visualization of hepatic arterial branches was scored by visual assessment. The highest aortic enhancement was observed in the first-pass acquisition in all groups. At the higher injection rate (groups 1 and 2), aortic enhancement in the first-pass acquisition was significantly more intense, whereas portal venous and hepatic enhancement was significantly less intense. The use of a flush considerably improved aortic enhancement at the beginning of the second-pass acquisition. In the visual assessment of hepatic arterial branches, the protocols with the higher injection rate received significantly higher grades. Multislice CT permits the entire liver to be imaged during an almost exclusively arterial phase by shortening the injection duration for a given volume of contrast material.

The role of contrast-enhanced MR mammography for determining candidates for breast conservation surgery.

Zhang Y, Fukatsu H, Naganawa S, Satake H, Sato Y, Ohiwa M, Endo T, Ichihara S, Ishigaki T

Breast Cancer Vol. 9 ( 3 ) page： 231-239 2002

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

PURPOSE: The aim of this study was to assess the impact of preoperative magnetic resonance mammography (MRM) on the surgical determination of breast conservation treatment for breast cancer patients. METHODS: From September 1997 to March 2000, 57 consecutive breast conservation treatment candidates were prospectively evaluated with conventional imaging studies (mammography and ultrasonography) and preoperative MRM. RESULTS: In 47 of 54 (87% ) breast cancer patients breast conservation surgery (BCS) was indicated on the basis of mammography (MMG) and ultrasonography (US). However in 40 of the 54 (74% ) patients BCS was indicated on the basis of MRM. Thirty-eight of the 40 patients ultimately underwent BCS and only 1 showed a positive margin. There were 7 patients whose MRM findings suggested that more aggressive treatment than BCS was needed but for whom US/MMG suggested that BCS was appropriate. Five of the 7 patients underwent mastectomy rather than BCS based on the MRM findings, which were justified by post-surgical histological findings. Of the 2 remaining patients who underwent BCS, one had a positive histological margin and one had recurrence, both of which resulted in salvage mastectomy. CONCLUSION: Our study suggests that high resolution preoperative MRM provides more accurate information compared with US and MMG for selecting candidates for BCS. Using MRM as a routine staging tool may reduce unnecessary repeated excisions. A larger study will be required to confirm these findings and to define the patients most likely to benefit from breast MR imaging.

Lung: feasibility of a method for changing tube current during low-dose helical CT.

Itoh S, Ikeda M, Mori Y, Suzuki K, Sawaki A, Iwano S, Satake H, Arahata S, Isomura T, Ozaki M, Ishigaki T

Radiology Vol. 224 page： 905-912 2002

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

A method for changing the tube current during helical scanning was applied to low-dose computed tomography (CT) in the lung. The changing method resulted in significant equalization of image noise in various lung sections compared with that at scanning with constant tube current. Detectability of nodules was equivalent between 60 mA and the changing method, whereas degradation occurred at 20 mA. This method seems feasible for the low-dose CT of lung cancer screening.

Pancreatic ductal adenocarcinoma showing iso-attenuation in early-phase contrast-enhanced CT: comparison with histopathological findings.

Itoh S, Satake H, Ohta T, Asai H, Endo T, Ishigaki T

Radiat Med Vol. 20 page： 59-67 2002

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

PURPOSE: To clarify the CT characteristics and histopathological findings of pancreatic ductal adenocarcinomas that are not detected in early-phase contrast-enhanced CT images. MATERIALS AND METHODS: The CT findings of eight patients with histopathologically proven pancreatic carcinomas that were not detected in early-phase images following the rapid injection of contrast material were reviewed. The examinations consisted of pre-contrast-enhanced CT and multi-phase contrast-enhanced CT, with thin-section scanning in each patient. The CT findings were compared with those of the resected specimens. RESULTS: In all cases but one, the lesion was in the pancreatic head. In seven cases, the tumor did not appear as a focal area of hypoattenuation compared with surrounding pancreatic parenchyma in early-phase images, and in the remaining case, small areas of poor enhancement were observed. In late-phase images, hyperattenuated and isoattenuated areas were seen in six and two cases, respectively. In all but one case, the lesion was less than 40 mm in size. All lesions were composed of acinar tissues and tumor cells, and contained small amounts of mucin, necrotic tissue, and pus. The fibrous tissues were not abundant and were interlobular and/or relatively loose. CONCLUSION: Pancreatic ductal adenocarcinomas showing isoattenuation in early-phase images tend to be relatively mild lesions with scirrhous and/or desmoplastic changes.

*Interobserver agreement and performance score comparison in quality control using a breast phantom: screen-film mammography vs computed radiography.

Shimamoto K, Ikeda M, Satake H, Ishigaki S, Sawaki A, Ishigaki T

Eur Radiol Vol. 12 page： 2192-2197 2002

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

Our objective was to evaluate interobserver agreement and to compare the performance score in quality control of screen-film mammography and computed radiography (CR) using a breast phantom. Eleven radiologists interpreted a breast phantom image (CIRS model X) by four viewing methods: (a) original screen-film; (b) soft-copy reading of the digitized film image; (c) hard-copy reading of CR using an imaging plate; and (d) soft-copy reading of CR. For the soft-copy reading, a 17-in. CRT monitor (1024x1536x8 bits) was used. The phantom image was evaluated using a scoring system outlined in the instruction manual, and observers judged each object using a three-point rating scale: (a) clearly seen; (b) barely seen; and (c) not seen. For statistical analysis, the kappa statistic was employed. For "mass" depiction, interobserver agreement using CR was significantly lower than when using screen-film ( p<0.05). There was no significant difference in the kappa value for detecting "microcalcification"; however, the performance score of "microcalcification" on CR hard-copy was significantly lower than on the other three viewing methods ( p<0.05). Viewing methods (film or CR, soft-copy or hard-copy) could affect how the phantom image is judged. Paying special attention to viewing conditions is recommended for quality control of CR mammograms.

Display method can affect interobserver agreement: comparison of 'zoom-and-pan' and 'browse-and-paste' for primary CT interpretation.

Hirota H, Shimamoto K, Ikeda M, Ishigaki T, Maruyama K, Yamada T, Satake H, Ishiguchi T, Takahashi Y, Nishihara E

Comput Med Imaging Graph Vol. 25 page： 327-333 2001

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

Eight radiologists interpreted body CT images of 30 cases using a viewing station (six 17-in. monitors, 1024x1280). Using two different display methods, 'zoom-and-pan' and 'browse-and-paste', the readers described the presence or absence of liver tumors using a five-point rating scale and temporal changes between the current and previous studies using a seven-point rating scale. There was no significant difference in kappa values for tumor detection between the two display modes. However, in describing temporal changes, the kappa value of the browse-and-paste was significantly lower than that of zoom-and-pan (p<0.01). Browse-and-paste may have the disadvantage of greater interobserver variation.

*Role of ultrasonography in the detection of intraductal spread of breast cancer: correlation with pathologic findings, mammography and MR imaging.

Satake H, Shimamoto K, Sawaki A, Niimi R, Ando Y, Ishiguchi T, Ishigaki T, Yamakawa K, Nagasaka T, Funahashi H

Eur Radiol Vol. 10 page： 1726-1732 2000

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

The purpose of this study was to assess the role of US in the detection of intraductal spread of breast cancer in comparison with mammography (MMG) and MRI. In 46 patients with breast cancer, US features of the intraductal component were classified as ductal type or distorted type. Histopathologically, 29 of 46 (63%) cases had intraductal components, and the sensitivity, specificity, and accuracy rates in detection of intraductal spread were 89, 76, and 85%, respectively. Each US pattern demonstrated good correspondence to the histologic components, and the distorted type correlated well with comedo-type carcinoma. Mammography was performed in all cases, and the sensitivity, specificity, and accuracy rates in detection of intraductal spread were 55, 100, and 72%, respectively. In comedo type, MMG could diagnose the extent of intraductal spread more accurately compared with US examination. Magnetic resonance imaging comparison was available in 25 cases. Magnetic resonance imaging depicted intraductal extension as an enhanced area during the early phase of a contrast enhancement study with a sensitivity of 93%. Ultrasound and MRI were closely related in terms of morphologic characteristics: the ductal type of US image correlated well with linear enhancement on MRI, whereas the distorted type correlated with regional or segmental enhancement. Current US examination is useful in depicting the intraductal spread of breast cancer; however, US has a tendency to underestimate intraductal component of comedo type compared with MMG and MRI.

Breast ultrasonography: diagnostic efficacy of a computer-aided diagnostic system using fuzzy inference.

Sawaki A, Shimamoto K, Satake H, Ishigaki T, Koyama S, Obata Y, Ikeda M

Radiat Med Vol. 17 page： 41-45 1999

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

We have developed a computer-aided diagnostic (CAD) system using fuzzy inference for breast sonography and have evaluated the performance of the system. Our CAD system is not an automated image processing method, but requires the observer's subjective "scoring." Seven radiologists interpreted 54 breast mass lesions (24 malignant, 30 benign). Six criteria (shape, border, halo, internal echoes, posterior echoes, and edge shadows) were scored using a five-point rating scale. The output was described as a real number from 0.0 to 1.0. For cancer diagnosis, the sensitivity of the radiologists, a six-criteria CAD version, and a four-criteria version (excluding posterior echoes and edge shadows) were 63.1%, 82.1%, and 78.0%, respectively. Specificity was 71.0%, 42.9%, and 51.0%, respectively, while accuracy was 67.5%, 60.3%, and 63.0%, respectively. No significant differences in the areas under ROC curve (Az) were found between the observers and CAD system. Several cases assessed as false-negative by observers were correctly diagnosed by the CAD system, and diagnostic efficacy could be improved, especially among novice sonographers. Although the system's high false-positive rate needs to be reduced, it will assist radiologists in generating a level of suspicion for malignancy.

Interobserver agreement in sonographic diagnosis of breast tumors.

Shimamoto K, Sawaki A, Ikede M, Satake H, Naganawa S, Tadokoro M, Isomura T, Hirota H, Ishigaki T

Eur J Ultrasound Vol. 8 ( 1 ) page： 25-31 1998

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

OBJECTIVE: To evaluate interobserver agreement in the interpretation of breast ultrasonography. METHODS: 55 breast masses (30 benign, 24 malignant) were interpreted by seven radiologists using a CRT viewing station. US criteria for differentiating between benign and malignant lesions included shape, border, boundary echoes, internal echoes, posterior echoes, and bilateral shadows. Each criterion and the observers' final impression was scored using the 5-point rating scales. For analyzing interobserver agreement, the kappa (kappa) values were employed. RESULTS: The kappa values of shape and posterior echoes were significantly higher than those of the other four criteria (P<0.05). Agreement was intermediate in border and internal echoes, and was low in boundary echoes and bilateral shadows. Agreement in the senior group (four observers) was relatively higher than that in the junior group (three observers) for all criteria but for internal echoes. Easily-diagnosed cases showed significantly higher kappa values compared with more ambiguous cases (P<0.05). CONCLUSION: Interobserver agreement in shape and posterior echoes was significantly higher than those of the other four criteria. Agreement was significantly dependent on case difficulty.Copyright 1998 Elsevier Science Ireland Ltd.

Preoperative staging of thyroid papillary carcinoma with ultrasonography.

Shimamoto K, Satake H, Sawaki A, Ishigaki T, Funahashi H, Imai T

Eur J Radiol Vol. 29 page： 4-10 1998

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

OBJECTIVE: To evaluate the usefulness of ultrasonography including Doppler flow imaging for the preoperative staging of thyroid papillary carcinoma. MATERIALS AND METHODS: In 77 patients with thyroid papillary carcinoma who underwent total thyroidectomy, the accuracy of ultrasonography in preoperative clinical staging was assessed with use of pathologic examination on the basis of TNM classification by the International Union Against Cancer (UICC). RESULTS: In 63 (81.8%) cases, T categories were estimated accurately. The sensitivity in depicting tumor extension into the prethyroidal muscle and/or the sternocleidomastoid muscle was 77.8%, whereas the sensitivity for invasion into the trachea and the esophagus was 42.9 and 28.6%, respectively. In 37 (48.1%) cases, N categories were underestimated, and the sensitivity in the detection of regional lymph node metastasis was 36.7%. Doppler flow imaging was performed in 36 patients, and no correlation was found between flow patterns and the presence of local invasion or regional lymph node metastasis. CONCLUSION: Ultrasonography was useful for preoperative investigation of thyroid papillary carcinoma, but several limitations existed, especially in evaluating extracapsular invasion to deep locations and regional lymph node metastasis.

*Value of ultrasonography and galactography in dilated ducts or cysts of the breast.

Satake H, Shimamoto K, Endo T, Ishigaki T, Funahashi H.

European Journal of Ultrasound Vol. 6 page： 127-130 1997.6

[Helical CT for lung-cancer screening: fourth report. Detectability of pulmonary lesions]

Itoh S, Satake H, Katoh T, Isomura T, Ikeda M, Ishigaki T

Nippon Igaku Hoshasen Gakkai Zasshi Vol. 56 page： 1039-1044 1996

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

The detectability of various abnormal findings in helical screening CT(HSCT) with low-dose and single-breath-hold scanning of the lung was examined using conventional CT as a gold standard. In 75 patients, HSCT was obtained with scanning parameters of 120kVp, 50 mA, 10 mm-collimation. 20 mm/second and 1 sec/rotation. Conventional CT was obtained with 150 mA and 10 mm-slice contiguous scanning HSCT depicted 141 of 159 focal lesions in nodules and masses (65 of 69 lesions more than 5mm in size), 44 of 47 in infiltrative lesions, 11 of 11 in reticular lesions and 23 of 39 in bullae and blebs. There were only 3 false positive lesions in nodule and mass. Sensitivity, specificity and accuracy of HSCT for diffuse lesions were 100% (11/11), 95% (61/64) and 96% (72/75) for fibrotic change and 75% (9/12), 100% (63/63) and 96% (72/75) for emphysematous change, respectively. Since the detectability of HSCT was good for abnormal findings, showing increased attenuation in comparison with the lung parenchyma, it was considered to be a promising method for lung-cancer screening.

[Helical CT for lung-cancer screening: third report: fundamental study for ultralow-dose CT by application of small tube current and filter]

Itoh S, Koyama S, Tusaka M, Maekoshi H, Satake H, Ishigaki T

Nippon Igaku Hoshasen Gakkai Zasshi Vol. 56 page： 961-966 1996

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

In order to develop ultra-low-dose helical CT for lung cancer screening, the effect of reduction of the tube current to 20mA and application of a 10mm thick aluminium filter upon radiation dose and image quality was evaluated with a phantom. Exposure dose at the center of a gantry and absorbed dose at the center of an acrylic phantom at 20mA with the filter were 15% and 29% of the dose at 50mA without the filter, respectively. For reduction of absorbed dose, reduction of the tube current was more useful than application of the filter. Image noise at 20mA with the filter was double that at 50mA without the filter. Neither reduction of the tube current nor application of the filter changed full width at half maximum on section sensitivity of the Z-axis. Although reduction of the tube current did not affect the difference in CT values between an acrylic sphere and styroform, application of the filter caused a reduction of 4.5% in the difference in CT values. Neither reduction of the tube current nor application of the filter affected the contrast resolution of the high-contrast phantom; however, that of the low-contrast phantom deteriorated. Although improvement of the filter and evaluation of clinical images are necessary, reduction of the tube current to 20mA and application of the aluminium filter appear to be a promising method for ultra-low-dose helical CT of the lung.

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Papers - SATAKE, Hiroko