Faculty Profiles - IWANO, Shingo

Papers - IWANO, Shingo

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Micro-computed tomography images of lung adenocarcinoma: Detection of lepidic growth patterns Reviewed

Shota Nakamura, Kensaku Mori, Shingo Iwano, Koji Kawaguchi, Takayuki Fukui, Shuhei Hakiri, Naoki Ozeki, Masahiro Oda, Kohei Yokoi

Nagoya Journal of Medical Science Vol. 82 ( 1 ) page： 25 - 31 2020.2

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

© 2020 Nagoya University. Micro-computed tomography (μCT) provides extremely high-resolution images of samples and can be employed as a non-destructive inspection tool. Using μCT, we can obtain images comparable with microscopic images. In this work, we have attempted to take high-resolution images of the human lung using μCT. Compared to clinical high-resolution computed tomography (HRCT) images of living body (in-vivo imaging), we can obtain extremely high-resolution images by μCT of ex-vivo tissues (resected lungs) as three-dimensional data. The purpose of this study was to distinguish between areas of normal lung and lung cancer by μCT images in order to study the feasibility of cancer diagnosis using this novel radiological image modality. Ten resected human lungs containing primary cancer were fixed by Heitzman's methods to obtain high-resolution μCT images. After fixation of the lung, images of the specimens were taken by μCT between January 2016 and November 2017. The imaging conditions were tube voltage: 90 kV and tube current: 110 μA. To compare details of images gained by conventional HRCT and μCT, we measured the thickness of the alveolar walls of the normal lung area and the cancer area of which alveoli might be replaced by tumor cells, and compared their appearance by means of histopathological images. All the nodules were diagnosed as adenocarcinoma. The median whole tumor size was 18 mm (9 mm-24 mm). Each specimen was clearly divided into areas of normal alveolar wall and of thickened alveolar wall on μCT 'visually'. Median thickness of alveolar walls of the normal lung was 0.037 mm (0.034 mm-0.048 mm), and that of the cancer area was 0.084 mm (0.074 mm-0.094 mm); there was a statistically significant difference between both thicknesses by Student's t-test (P < 0.01). The area of thickened alveolar walls on μCT corresponded well with the area of microscopically lepidic growth patterns of adenocarcinoma. We found that μCT images could be correctly divided by alveolar walls into normal lung area and lung cancer area. Further detailed investigations with regard to μCT are needed to make comparable histological diagnoses using μCT images with conventional microscopic methods of pathological diagnoses.

DOI： 10.18999/nagjms.82.1.25

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Scopus

PubMed

中枢神経系原発anaplastic lymphoma kinase陽性未分化大細胞リンパ腫の1例

佐々木裕太郎, 中道玲瑛, 伊藤信嗣, 川井恒, 岩野信吾, 田岡俊昭, 加藤克彦, 川島直美, 下山芳江, 長縄慎二

映像情報Medical Vol. 52 ( 1 ) page： 82 - 83 2020.1

Kinetic volume analysis on dynamic contrast-enhanced MRI of triple-negative breast cancer: associations with survival outcomes. Reviewed International journal

Yoko Hayashi, Hiroko Satake, Satoko Ishigaki, Rintaro Ito, Mariko Kawamura, Hisashi Kawai, Shingo Iwano, Shinji Naganawa

The British journal of radiology Vol. 93 ( 1106 ) page： 20190712 - 20190712 2020

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

OBJECTIVE: To evaluate the associations between computer-aided diagnosis (CAD)-generated kinetic volume parameters and survival in triple-negative breast cancer (TNBC) patients. METHODS: 40 patients with TNBC who underwent pre-operative MRI between March 2008 and March 2014 were included. We analyzed CAD-generated parameters on dynamic contrast-enhanced MRI, visual MRI assessment, and histopathological data. Cox proportional hazards models were used to determine associations with survival outcomes. RESULTS: 12 of the 40 (30.0%) patients experienced recurrence and 7 died of breast cancer after a median follow-up of 73.6 months. In multivariate analysis, higher percentage volume (%V) with more than 200% initial enhancement rate correlated with worse disease-specific survival (hazard ratio, 1.12; 95% confidence interval, 1.02-1.22; p-value, 0.014) and higher %V with more than 100% initial enhancement rate followed by persistent curve type at 30% threshold correlated with worse disease-specific survival (hazard ratio, 1.33; 95% confidence interval, 1.10-1.61; p-value, 0.004) and disease-free survival (hazard ratio, 1.27; 95% confidence interval, 1.12-1.43; p-value, 0.000). CONCLUSION: CAD-generated kinetic volume parameters may correlate with survival in TNBC patients. Further study would be necessary to validate our results on larger cohorts. ADVANCES IN KNOWLEDGE: CAD generated kinetic volume parameters on breast MRI can predict recurrence and survival outcome of patients in TNBC. Varying the enhancement threshold improved the predictive performance of CAD generated kinetic volume parameter.

DOI： 10.1259/bjr.20190712

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PubMed

Prognostic Impact and Risk Factors of Immune-Related Pneumonitis in Patients With Non-Small-Cell Lung Cancer Who Received Programmed Death 1 Inhibitors. International journal

Jun Fukihara, Koji Sakamoto, Junji Koyama, Takayasu Ito, Shingo Iwano, Masahiro Morise, Masahiro Ogawa, Yasuhiro Kondoh, Tomoki Kimura, Naozumi Hashimoto, Yoshinori Hasegawa

Clinical lung cancer Vol. 20 ( 6 ) page： 442 - + 2019.11

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

INTRODUCTION: Pneumonitis is one of the immune-related adverse events of programmed death 1 (PD-1) inhibitors that sometimes cause lethal outcomes. Although some recent reports have described PD-1 inhibitors as more effective in non-small-cell lung cancer (NSCLC) patients with immune-related adverse events than in those without, few data are available on the prognosis of those treated with PD-1 inhibitors who developed immune-related pneumonitis (IRP). Additionally, the robust risk factors of IRP have not been well elucidated. PATIENTS AND METHODS: A retrospective review of patients with recurrent or advanced NSCLC who took a PD-1 inhibitor (nivolumab or pembrolizumab monotherapy) between January 2016 and March 2018 was undertaken. Radiologic findings such as unilateral infiltration were also defined as IRP as long as they were deemed relevant to PD-1 inhibitors. RESULTS: Twenty-seven (16%) of 170 patients developed IRP. Although 22 (81%) of 27 patients with IRP recovered with drug cessation with or without corticosteroid therapy, 8-week landmark analysis showed the overall survival after administration of the PD-1 inhibitor was significantly shorter in patients with IRP than in those without (8.7 vs. 23.0 months, P = .015). Patients with IRP tended to not receive next-line treatment and choose best supportive care after cessation of PD-1 inhibitor therapy. In the multivariate analysis, pembrolizumab (vs. nivolumab) and low serum albumin were independent risk factors for IRP. CONCLUSION: Development of IRP was correlated with poor prognosis in patients with NSCLC. Further study is necessary for establishing the best prediction and management strategies for IRP.

DOI： 10.1016/j.cllc.2019.07.006

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PubMed

ディープラーニングを用いた胸部CT像中の肺結節の画像所見の検出および良悪性鑑別

福嶋一茂, 平野靖, 木戸尚治, 岩野信吾

MEDICAL IMAGING TECHNOLOGY Vol. 37 ( 5 ) page： 244 - 253 2019.11

Language：Japanese Publisher：日本医用画像工学会

近年、コンピューター診断支援(computer-aided diagnosis;CADx)システムに関する研究では、ディープラーニングが使用される機会が多くなってきており、従来よりも高い性能を示すことが報告されている。肺結節の良悪性鑑別のためのCADxシステムでも同様の傾向があるが、それらはCT像などを入力とし、良性あるいは悪性の尤度のみを出力するか、クラス分類するものが一般的である。一方で、患者に対して医師が肺結節の診断結果を説明する際には、良悪性の尤度だけでは不十分であり、診断結果の根拠を説明することが求められる。そこで本研究ではディープラーニングの一形態であるCNN(convolutional neural network)を用いて、CT像中の肺結節が悪性であることを示唆する画像所見の存在の尤度を診断の根拠として提供し、さらにそれらの尤度を入力するNN(neural network)によって良悪性の鑑別結果を医師に提供するCADxシステムの構築を行った。55個の良性結節と120個の悪性結節を用いて本手法の性能を評価した結果、識別率は79.02±8.43[%]となった。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J02087&link_issn=&doc_id=20200115200004&doc_link_id=%2Fen9meite%2F2019%2F003705%2F004%2F0244-0254%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fen9meite%2F2019%2F003705%2F004%2F0244-0254%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Multi-window levels and widths imaging 画像変換による新たな読影手法の検討

伊藤倫太郎, 岩野信吾, 小田紘久, 森健策, 長縄慎二

日本医学放射線学会秋季臨床大会抄録集 Vol. 55回 page： S531 - S532 2019.9

＜Editors' Choice＞ Renewed Japanese spirometric reference variables and risk stratification for postoperative outcomes in COPD patients with resected lung cancer.

Yu Okada, Naozumi Hashimoto, Shingo Iwano, Koji Kawaguchi, Takayuki Fukui, Koji Sakamoto, Kenji Wakai, Kohei Yokoi, Yoshinori Hasegawa

Nagoya journal of medical science Vol. 81 ( 3 ) page： 427 - 438 2019.8

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

Although the lower limit of normal (LLN) of FEV1/FVC detects at-risk patients for postoperative outcomes among Japanese chronic obstructive pulmonary disease (COPD) patients with resected lung cancer, there was a lack of a Japanese reference equation to calculate the LLN of FEV1/FVC. Renewed Japanese spirometric reference variables might enable us to verify clinical impact of the LLN of FEV1/FVC among the Japanese population. To evaluate the clinical impact of the LLN of FEV1/FVC by using this renewed reference, data were retrospectively analyzed from 609 newly diagnosed lung cancer patients who had undergone thoracic surgery between 2006 and 2011. The combined assessment of the 0.70 fixed ratio and the LLN of the FEV1/FVC ratio classified the 609 subjects into the COPD (214 subjects), non-COPD (337 subjects), and in-between (58 subjects) groups, respectively. All of the relative odds ratios (ORs) of postoperative outcomes for the comparison between the in-between and non-COPD groups did not show significant confidence intervals (CIs). On the other hand, the adjusted ORs of postoperative outcomes for the COPD group versus the non-COPD group were 2.840 (95% CI: 1.824-4.421) for prolonged oxygen therapy (POT), 1.836 (95% CI: 1.166-2.890) for prolonged postoperative stays, and 1.637 (95% CI: 1.007-2.663) for combined complications. Adjusted comparisons of POT between the in-between and COPD groups also showed a significant relative OR of 2.984 (95% CI: 1.447-6.153). A standardized assessment of the LLN of FEV1/FVC by a renewed Japanese spirometric reference provides risk stratification for postoperative outcomes in the population.

DOI： 10.18999/nagjms.81.3.427

Web of Science

PubMed

Utility of Metabolic Parameters on FDG PET/CT in the Classification of Early-Stage Lung Adenocarcinoma: Prediction of Pathological Invasive Size. Reviewed International journal

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

Clinical nuclear medicine Vol. 44 ( 7 ) page： 560 - 565 2019.7

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

PURPOSE: This paper aims to explore the role of a metabolic parameter on F-FDG-PET/CT for clinical T-classification in early-stage adenocarcinoma. PATIENTS AND METHODS: One hundred six surgically resected pathological TNM stage (p-stage) 0/I lung adenocarcinomas were retrospectively reviewed. The solid size (SS) measured on thin-section CT and the pathological invasive size (IS) of tumors were recorded. The SUVmax and metabolic tumor volume with SUV ≥1.0 (MTV1.0) derived from PET/CT data were measured on a workstation, and the metabolic tumor diameter with SUV ≥1.0 (MTD1.0) was calculated automatically from MTV1.0. For the correlations between the IS and the SS, MTD1.0, or SUVmax, Pearson's correlation coefficients were compared using the Meng-Rosenthal-Rubin method. Additionally, the reproducibility between the clinical TNM stage (c-stage), based on the SS or MTD1.0, and the p-stage was analyzed using the kappa coefficient (k). RESULTS: For the correlations between the IS and the other parameters, Pearson correlation coefficient was 0.630 for the SS, 0.600 for the SUVmax, and 0.725 for MTD1.0. MTD1.0 correlated significantly and more strongly with the IS than the SS and the SUVmax did (P = 0.040, and P = 0.008, respectively). The reproducibility between p-stage and c-stage based on the SS was moderate (k = 0.529, P < 0.001), whereas that between p-stage and c-stage based on MTD1.0 was substantial (k = 0.676, P < 0.001). CONCLUSIONS: MTD1.0 on FDG-PET/CT was correlated significantly and more strongly with the pathological IS in lung adenocarcinomas than with the SS on thin-section CT. FDG-PET/CT could classify more precisely early-stage lung adenocarcinoma than the presently used T-classification based on thin-section CT findings.

DOI： 10.1097/RLU.0000000000002591

Web of Science

PubMed

【人工知能が医療を変える!医療分野におけるAI研究開発最前線2019】領域別・画像診断におけるAI研究開発の最前線胸部領域胸部画像診断におけるAIと臨床研究について

伊藤倫太郎, 岩野信吾, 長縄慎二

INNERVISION Vol. 34 ( 7 ) page： 25 - 28 2019.6

Language：Japanese Publisher：(株)インナービジョン

2006年から始まった第三次AIブームによりAIの研究が加速度的に進み、現在ではスマートフォンのカメラや音声入力など身近なものに活用されている。放射線医学においては古くから人工知能(AI)を用いた研究が行われ、臨床にも応用されていた。最近では、さらに発展したAIを用いたCADの開発が盛んであり、世界中の研究者が開発を競っている。本稿では、加速度的に進歩するAIと放射線医学とのかかわりについて、主に胸部画像診断の観点から現在の状況と問題点についてまとめ、実際の研究例について提示する。(著者抄録)

画像診断と病理食道平滑筋腫

兵藤良太, 岩野信吾, 長縄慎二, 宮田一志, 島田聡子

画像診断 Vol. 39 ( 7 ) page： 662 - 663 2019.5

Association between chest computed tomography findings and respiratory adverse events in rheumatoid arthritis patients undergoing long-term biological therapy. Reviewed

Matsumoto T, Iwano S, Takahashi N, Asai S, Watanabe T, Asai N, Sobue Y, Ito S, Ishiguro N, Kojima T

International journal of rheumatic diseases Vol. 22 ( 4 ) page： 626 - 635 2019.4

FDG-PET/CTの腫瘍代謝容積に基づいた肺腺癌の臨床病期診断の試み

岩野信吾, 伊藤倫太郎, 長縄慎二

肺癌 Vol. 59 ( 2 ) page： 189 - 189 2019.4

Longitudinal changes in pulmonary function and respiratory impedance of rheumatoid arthritis Reviewed

Isobe Y, Ito S, Matsuda T, Iwano S, Uchida A, Takahashi N, Kojima T, Wakahara K, Yamaguchi E, Hasegawa Y

Respiratory Physiology Neurobiology Vol. 261 page： 1 - 8 2019.3

Quantitative Follow-Up Assessment of Patients with Interstitial Lung Disease by 3D-Curved High-Resolution CT Imaging Parallel to the Chest Wall. Reviewed

Hiroyasu Umakoshi, Shingo Iwano, Tsutomu Inoue, Yuanzhong Li, Keigo Nakamura, Shinji Naganawa

Nagoya journal of medical science Vol. 81 ( 1 ) page： 41 - 53 2019.2

Language：English

We evaluated the progression of interstitial lung disease (ILD) by three-dimensional curved high-resolution computed tomography (3D-cHRCT) at a constant depth from the chest wall and compare the results to pulmonary function test (PFT) results on a follow-up assessment. We reviewed the patients with ILD who underwent HRCT and concurrent PFTs at least twice from April 2008 to December 2014. Forty-five patients with ILD were enrolled. 3D-cHRCT images of the lung at various depths from the chest wall were reconstructed, and total area (TA), high-attenuation area (HAA) >-500 HU, and %HAA ([HAA/TA] × 100) were calculated. The TA, HAA, and %HAA ratios (follow-up to baseline) were assessed for use in the diagnosis of physiologically progressive ILD (defined as; forced vital capacity [FVC] ratio <0.9 or %diffusing capacity of the lung for carbon monoxide [%DLCO] ratio <0.85 [follow-up to baseline]). Of all ratios obtained from 3D-cHRCT images at 5-30mm depths, the %HAA ratio at 20-mm had the largest area under the receiver operating characteristic curve (0.815, 95 % confidence interval 0.677-0.953). By univariate logistic regression analysis, TA, HAA, and %HAA ratios at 20-mm showed significant correlations with physiologically progressive ILD. 3D-cHRCT imaging performed in parallel with the chest wall offers novel quantitative parameters that are useful for following ILD.

DOI： 10.18999/nagjms.81.1.41

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PubMed

原発性肺癌の術前臨床病期診断の正確性

岩野信吾, 馬越弘泰, 伊藤倫太郎, 島本宏矩, 長縄慎二

Japanese Journal of Radiology Vol. 37 ( Suppl. ) page： 25 - 25 2019.2

Effect of blood glucose level on standardized uptake value (SUV) in <sup>18</sup>F- FDG PET-scan: a systematic review and meta-analysis of 20,807 individual SUV measurements. Reviewed

Eskian M, Alavi A, Khorasanizadeh M, Viglianti BL, Jacobsson H, Barwick TD, Meysamie A, Yi SK, Iwano S, Bybel B, Caobelli F, Lococo F, Gea J, Sancho-Muñoz A, Schildt J, Tatcı E, Lapa C, Keramida G, Peters M, Boktor RR, John J, Pitman AG, Mazurek T, Rezaei N

European journal of nuclear medicine and molecular imaging Vol. 46 ( 1 ) page： 224 - 237 2019.1

Detection of Medical Image Findings and Discrimination between Benign and Malignant Nodules in Chest CT Images by Using Deep Learning

FUKUSHIMA Kazushige, HIRANO Yasushi, KIDO Shoji, IWANO Shingo

Medical Imaging Technology Vol. 37 ( 5 ) page： 244 - 254 2019

Language：Japanese Publisher：The Japanese Society of Medical Imaging Technology

<p>Computer-aided diagnosis (CADx) systems based on deep learning have been actively researched in recent years, and it has been reported to exhibit their high performance. The CADx systems for benign and malignant discrimination exhibit a similar tendency. They generally convert input medical images into likelihood of their benignancy and malignancy. On the other hand, when medical doctors explain the diagnosis to patients, they need to explain not only the likelihood of malignancy of the lung nodule but also basis of the diagnosis. In this paper, we proposed a CADx system which provides medical doctor with likelihood of the existence of the medical image finding related to lung cancer CNN (convolutional neural network) for obtaining the likelihood of the medical image findings, and NN (neural network) for obtaining the likelihood of the malignancy of the lung nodule. As a result of evaluating the performance of the proposed system using 55 benign and 120 malignant nodules, the discrimination rate was 79.02±8.43 [%].</p>

DOI： 10.11409/mit.37.244

Generative Adversarial Networkを用いた肺結節の画像生成について

伊藤倫太郎, 岩野信吾, 長縄慎二

日本医学放射線学会秋季臨床大会抄録集 Vol. 54回 page： S561 - S561 2018.9

Impact of Patient Age and Histological Type on Radioactive Iodine Avidity of Recurrent Lesions of Differentiated Thyroid Carcinoma Reviewed

Kenichi Nakanishi, Toyone Kikumori, Noriyuki Miyajima, Yuko Takano, Sumiyo Noda, Dai Takeuchi, Shingo Iwano, Yasuhiro Kodera

Clinical Nuclear Medicine Vol. 43 ( 7 ) page： 482 - 485 2018.7

Language：English Publishing type：Research paper (scientific journal) Publisher：Lippincott Williams and Wilkins

Background Age is a prognostic factor for recurrent differentiated thyroid carcinoma (DTC) and may be related to radioactive iodine (RAI) nonavidity. Indications for molecular-targeted drugs (MTDs) are currently limited to RAI-refractory DTC. Demonstrating refractoriness to RAI, mainly indicated by RAI nonavidity, may be a barrier to the introduction of MTDs for elderly patients. The present study was conducted to evaluate the impact of age and histological type on the RAI avidity of recurrent lesions of DTC. Methods Two hundred fifty-eight patients (189 patients with classic papillary thyroid carcinoma [cPTC], 8 patients with follicular variant of papillary thyroid carcinoma, and 61 patients with follicular thyroid carcinoma), who underwent their first RAI whole-body scanning for recurrent DTC at our institution between 2004 and 2013, were retrospectively studied. Radioactive iodine uptake was determined by visible uptake by metastatic lesion(s) in a diagnostic RAI-whole-body scan. Results The prevalence of RAI-avid lung metastases in cPTC indicated a significant, inverse correlation with age (&lt
55 years, 36.2%
≥55 years, 3%
P &lt
0.001). By contrast, for follicular thyroid carcinoma, the prevalence of RAI avidity was not influenced by age. Similar tendencies were observed for lymph node metastases. Conclusions Radioactive iodine avidity by metastatic lesions of cPTC in elderly patients, especially those older than 55 years, was seldom demonstrated. Adherence to a strategy of restricting MTD administration after confirmation of RAI refractoriness should be revisited for elderly patients. A strategy of omitting RAI treatment should be taken into account when considering age and histological type.

DOI： 10.1097/RLU.0000000000002078

Web of Science

Scopus

PubMed

Deep Learningを用いた胸部CT像中の肺結節の画像所見の検出および良悪性鑑別

福嶋一茂, 平野靖, 木戸尚治, 岩野信吾

日本医用画像工学会大会予稿集 Vol. 37回 page： 173 - 181 2018.7

Language：Japanese Publisher：日本医用画像工学会

近年、コンピュータ診断支援(Computer-Aided Diagnosis,CADx)システムに関する研究では、Deep Learningが使用される機会が多くなってきており、従来よりも高い性能を示すことが報告されている。肺結節の良悪性鑑別のためのCADxシステムでも同様の傾向があるが、それらはCT像等を入力とし、良性あるいは悪性の尤度のみを出力するか、クラス分類するものが一般的である。一方で患者に対して医師が肺結節の診断結果を説明する際には、良悪性の尤度だけでは不十分であり、診断結果の根拠を説明することが求められる。そこで本研究ではDeep Learningの一形態であるCNN(Convolutional Neural Network)を用いて、CT像中の肺結節が悪性であることを示唆する画像所見の存在の尤度を診断の根拠として提供し、さらにそれらの尤度を入力とするNN(Neural Network)によって良悪性の鑑別結果を医師に提供するCADxシステムの構築を行った。55個の良性結節と120個の悪性結節を用いて本手法の性能を評価した結果、識別率は79.02±8.43[%]となった。(著者抄録)

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Papers - IWANO, Shingo