Faculty Profiles - IWANO, Shingo

Measurement of solid size in early-stage lung adenocarcinoma by virtual 3D thin-section CT applied artificial intelligence. International journal Open Access

Shingo Iwano, Shinichiro Kamiya, Rintaro Ito, Akira Kudo, Yoshiro Kitamura, Keigo Nakamura, Shinji Naganawa

Scientific reports Vol. 13 ( 1 ) page： 21709 - 21709 2023.12

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

An artificial intelligence (AI) system that reconstructs virtual 3D thin-section CT (TSCT) images from conventional CT images by applying deep learning was developed. The aim of this study was to investigate whether virtual and real TSCT could measure the solid size of early-stage lung adenocarcinoma. The pair of original thin-CT and simulated thick-CT from the training data with TSCT images (thickness, 0.5-1.0 mm) of 2700 pulmonary nodules were used to train the thin-CT generator in the generative adversarial network (GAN) framework and develop a virtual TSCT AI system. For validation, CT images of 93 stage 0-I lung adenocarcinomas were collected, and virtual TSCTs were reconstructed from conventional 5-mm thick-CT images using the AI system. Two radiologists measured and compared the solid size of tumors on conventional CT and virtual and real TSCT. The agreement between the two observers showed an almost perfect agreement on the virtual TSCT for solid size measurements (intraclass correlation coefficient = 0.967, P < 0.001, respectively). The virtual TSCT had a significantly stronger correlation than that of conventional CT (P = 0.003 and P = 0.001, respectively). The degree of agreement between the clinical T stage determined by virtual TSCT and the clinical T stage determined by real TSCT was excellent in both observers (k = 0.882 and k = 0.881, respectively). The AI system developed in this study was able to measure the solid size of early-stage lung adenocarcinoma on virtual TSCT as well as on real TSCT.

DOI： 10.1038/s41598-023-48755-5

Open Access

Prognostic impact of highly solid component in early-stage solid lung adenocarcinoma. Reviewed International journal

Taketo Kato, Shingo Iwano, Yuki Hanamatsu, Masato Nakaguro, Ryo Emoto, Shoji Okado, Keiyu Sato, Osamu Noritake, Keita Nakanishi, Yuka Kadomatsu, Harushi Ueno, Naoki Ozeki, Shota Nakamura, Koichi Fukumoto, Tamotsu Takeuchi, Kennosuke Karube, Shigeyuki Matsui, Toyofumi Fengshi Chen-Yoshikawa

Quantitative imaging in medicine and surgery Vol. 13 ( 9 ) page： 5641 - + 2023.9

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

BACKGROUND: Based on computed tomography (CT) findings of lung cancer, solid nodules have a much worse prognosis than subsolid nodules, even if the nodules are subcentimeter in size. There is, however, no systematic method for determining the prognosis of solid tumors on CT. This study aimed to discover the prognostic factor of early-stage solid lung adenocarcinoma using three-dimensional CT volumetry. METHODS: Patients with pathological stage I solid lung adenocarcinoma who underwent complete resection between 2007 and 2012 were selected in this retrospective study. Clinicopathological data and preoperative multidetector CT findings, such as tumor size on the two-dimensional axial image, three-dimensional tumor volume between -600 and 199 HU, and three-dimensional solid volume between 0 and 199 HU, which corresponded to highly solid components, were compared between recurrence and non-recurrence. Furthermore, these radiological values were compared to pathological invasive volume (PIV). RESULTS: During this time, 709 patients had their lung cancer completely removed. From this cohort, 90 patients with pathological stage I solid lung adenocarcinoma were selected. In addition, recurrence was found in 26 patients (28.9%). Although two-dimensional axial image, serum carcinoembryonic antigen (CEA) level, and SUVmax on 18F fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) did not differ statistically between recurrent and non-recurrent patients, three-dimensional tumor and solid tumor volume did. Multivariate analysis indicated that three-dimensional solid tumor volume [hazard ratio: 2.440; 95% confidence interval (CI): 1.110-5.361, P=0.026] and epidermal growth factor receptor (EGFR) mutation (hazard ratio: 4.307; 95% CI: 1.328-13.977, P=0.015) were significantly associated with disease-free survival (DFS). When three-dimensional tumor and solid tumor volume were compared to PIV, three-dimensional solid tumor volume (3,091 mm3 on average) showed a highly similar value with PIV (2,930 mm3 on average), whereas three-dimensional tumor volume (6,175 mm3 on average) was significantly larger than PIV (P<0.001). CONCLUSIONS: In patients with early-stage solid lung adenocarcinoma, the measurement of three-dimensional solid tumor volume, which is correlated with PIV, accurately predicted the postoperative outcome.

DOI： 10.21037/qims-23-36

Virtual Bronchoscopy-Guided Transbronchial Biopsy Simulation Using a Head-Mounted Display: A New Style of Flexible Bronchoscopy. Reviewed International journal

Shotaro Okachi, Takayasu Ito, Kazuhide Sato, Shingo Iwano, Yuka Shinohara, Hideyuki Itoigawa, Naozumi Hashimoto

Surgical innovation Vol. 29 ( 6 ) page： 811 - 813 2022.12

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

Background/need. The increases in reference images and information during bronchoscopy using virtual bronchoscopic navigation (VBN) and fluoroscopy has potentially created the need for support using a head-mounted display (HMD) because bronchoscopists feel difficulty to see displays that are at a distance from them and turn their head and body in various directions. Methodology and device description. The binocular see-through Moverio BT-35E Smart Glasses can be connected via a high-definition multimedia interface and have a 720p high-definition display. We developed a system that converts fluoroscopic (live and reference), VBN, and bronchoscopic image signals through a converter and references them using the Moverio BT-35E. Preliminary results. We performed a virtual bronchoscopy-guided transbronchial biopsy simulation using the system. Four experienced pulmonologists performed a simulated bronchoscopy of 5 cases each with the Moverio BT-35E glasses, using bronchoscopy training model. For all procedures, the bronchoscope was advanced successfully into the target bronchus according to the VBN image. None of the operators reported eye or body fatigue during or after the procedure. Current status. This small-scale simulation study suggests the feasibility of using a HMD during bronchoscopy. For clinical use, it is necessary to evaluate the safety and usefulness of the system in larger clinical trials in the future.

DOI： 10.1177/15533506211068928

Diagnostic value and safety of endobronchial ultrasonography with a guide sheath transbronchial biopsy for diagnosing peripheral pulmonary lesions in patients with interstitial lung disease. Reviewed International journal

Takayasu Ito, Shotaro Okachi, Shingo Iwano, Fumie Kinoshita, Keiko Wakahara, Naozumi Hashimoto, Toyofumi Fengshi Chen-Yoshikawa

Journal of thoracic disease Vol. 14 ( 11 ) page： 4361 - 4371 2022.11

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

BACKGROUND: Radial endobronchial ultrasonography transbronchial biopsy with and without a guide sheath is a useful method for diagnosing peripheral pulmonary lesions (PPLs). However, the diagnostic yield and complications of radial endobronchial ultrasonography transbronchial biopsy for PPLs remains elusive in patients with interstitial lung disease (ILD). METHODS: We retrospectively analysed 431 patients (69 with and 362 without ILD) who underwent radial endobronchial ultrasonography with a guide sheath transbronchial biopsy (EBUS-GS TBB) for PPLs from April 1, 2011, to March 31, 2020. We investigated the diagnostic yield and complications of the procedure for PPLs and compared them between patients with and without ILD. We also evaluated the factors contributing to successful diagnosis. RESULTS: The diagnostic yield of radial endobronchial ultrasonography in patients with ILD was significantly lower than in those without ILD (62.3% vs. 75.4%, P=0.024). Multivariate analysis showed that the presence of ILD as background lung [odds ratio (OR) =0.517], probe position within the lesion (OR =4.654), and the presence of solid lesion (OR =1.946) significantly affected the diagnostic yield of PPLs. There was a significant difference in the rate of pneumothorax between the patients with ILD and those without ILD (4.3% vs. 0.6%, P=0.031). CONCLUSIONS: The presence of ILD as the background lung significantly affected the diagnostic yield of PPLs with radial EBUS-GS TBB. Regarding the complications, pneumothorax occurred more frequently in patients with ILD than in those without ILD.

DOI： 10.21037/jtd-22-809

Chest three-dimensional-computed tomography imaging data analysis for the variation of exercise capacity after lung lobectomy. Reviewed International journal

Naoki Ozeki, Shingo Iwano, Shota Nakamura, Koji Kawaguchi, Yota Mizuno, Takayuki Inoue, Motoki Nagaya, Toyofumi Fengshi Chen-Yoshikawa

Clinical physiology and functional imaging Vol. 42 ( 5 ) page： 362 - 371 2022.9

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

BACKGROUND: Postoperative loss of exercise capacity and pulmonary function is a major concern among lung cancer patients. In this study, the time for a stair-climbing to 12-m height was used to investigate whether preoperative chest 3D-computed tomography (CT) could be a useful tool for predicting postoperative variations in exercise capacity and pulmonary function. METHODS: Seventy-eight patients undergoing lobectomy for suspected stage I lung cancer were prospectively enroled. Preoperatively, lobe volume and low attenuation volume (LAV) were evaluated using the SYNAPSE VINCENT system. Preoperative data on stair-climbing time, spirometry and diffusing capacity of the lung for carbon monoxide (DLCO ) at baseline and 6-month postoperative data were used to evaluate variations in exercise capacity and pulmonary function. Maximal oxygen uptake (VO2 t) was evaluated based on the stair-climbing time. RESULTS: Significant differences in the variation of exercise capacity at 6 months postoperatively were found between the groups categorized by target lobe volume and LAV status: The large volume/LAV (+) group had a greater decline in VO2 t. Mean loss of VO2 t was -6.2%, -1.4%, -1.6% and -0.1% in the large volume/LAV (+), large volume/LAV (-), small volume/LAV (+) and small volume/LAV (-) groups, respectively. The large volume/LAV (-) group had a greater decline in forced expiratory volume in 1 s. The small volume/LAV (+) group showed a reduced decline in the DLCO . CONCLUSIONS: Analysis of chest 3D-CT scans is a potential tool for predicting the loss of exercise capacity and pulmonary function after lung lobectomy.

DOI： 10.1111/cpf.12777

Features from MRI texture analysis associated with survival outcomes in triple-negative breast cancer patients. Reviewed

人工知能を応用したバーチャル3D thin-section CTを用いた肺腺癌の充実成分径の計測

岩野信吾, 神谷晋一朗, 伊藤倫太郎, 工藤彰, 北村嘉郎, 中村圭児, 長縄慎二

断層映像研究会雑誌 Vol. 49 ( 2 ) page： 39 - 39 2022.9

Saki Kamiya, Hiroko Satake, Yoko Hayashi, Satoko Ishigaki, Rintaro Ito, Mariko Kawamura, Toshiaki Taoka, Shingo Iwano, Shinji Naganawa

Breast cancer (Tokyo, Japan) Vol. 29 ( 1 ) page： 164 - 173 2022.1

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

PURPOSE: The purpose of the study is to evaluate the associations between intratumoral or peritumoral textural features derived from pretreatment magnetic resonance imaging (MRI) and recurrence-free survival (RFS) in triple-negative breast cancer (TNBC) patients. METHODS: Forty-three patients with TNBC who underwent preoperative MRI between February 2008 and March 2014 were included. We performed two-dimensional texture analysis on the intratumoral or peritumoral region of interest (ROI) on axial of T2-weighted image (T2WI), dynamic contrast-enhanced (DCE)-MRI and DCE-MRI subtraction images. We also analyzed histopathological data. Cox proportional hazards models were used to investigate associations with survival outcomes. RESULTS: Twelve of the 43 patients (27.9%) had recurrence disease, at a median of 32.5 months follow-up (1.4-61.5 months). In univariate analysis, nine texture features in T2WI and DCE-MRI subtraction images were significantly associated with RFS. In multivariate analysis, intratumoral difference entropy in DCE-MRI subtraction images in the initial phase (hazard ratio 11.71; 95% confidence interval (CI) [1.41, 97.00]; p value 0.023) and, peritumoral difference variance in DCE-MRI subtraction images in the delayed phase (hazard ratio 9.60; 95% CI [1.98, 46.51]; p value 0.005), were both independently associated with RFS. Moreover, multivariate analysis revealed the presence of lymphovascular invasion as independently associated with RFS (hazard ratio 8.13; 95% CI [2.16, 30.30]; p value 0.002). CONCLUSIONS: At pretreatment MRI, an intratumoral and peritumoral quantitative approach using texture analysis has the potential to serve as a prognostic marker in patients with TNBC.

DOI： 10.1007/s12282-021-01294-1

Incidental findings on computed tomography for preoperative assessment before transcatheter aortic valve implantation in Japanese patients. Reviewed

Akihiro Tobe, Akihito Tanaka, Yoshiyuki Tokuda, Yusuke Miki, Kenji Furusawa, Sho Akita, Taro Fujii, Yoshinori Tsutsumi, Hideki Ishii, Shingo Iwano, Shinji Naganawa, Akihiko Usui, Toyoaki Murohara

Heart and vessels Vol. 36 ( 12 ) page： 1911 - 1922 2021.12

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

Extra-cardiovascular incidental findings (IFs) on preoperative computed tomography (CT) are frequently observed in transcatheter aortic valve implantation (TAVI) candidates. However, the backgrounds of TAVI candidates and comorbidities differ based on the race and/or country, and data on IFs in a specific population are not always applicable to another. The aim of this study was to assess the prevalence, type, and clinical impact of IFs in Japanese TAVI candidates. This was a retrospective, single-center, observational study. CT reports of 257 TAVI candidates were reviewed, and IFs were classified as (a) insignificant: findings that did not require further investigation, treatment, or follow-up; (b) intermediate: findings that needed to be followed up or were considered for further investigation but did not affect the planning of TAVI; and (c) significant: findings that required further investigation immediately or affected the planning of TAVI. At least one IF was found in 254 patients (98.8%). Insignificant, intermediate, and significant IFs were found in 253 (98.4%), 153 (59.5%), and 34 (13.2%) patients, respectively. Newly indicated significant IFs were found in 19 patients (7.4%). In 2 patients (0.8%), TAVI was canceled because of significant IFs. In patients who consequently underwent TAVI, the presence of significant IFs was not associated with the duration from CT performance to TAVI [28 (19-40) days vs. 27 (19-43) days, p = 0.74] and all-cause mortality during the median follow-up period of 413 (223-805) days (p = 0.44). Almost all Japanese TAVI candidates had at least one IF, and the prevalence of significant IFs was not negligible. Although the presence of significant IFs was not associated with mid-term mortality, appropriate management of IFs was considered important.

DOI： 10.1007/s00380-021-01875-2

Diagnostic utility of metabolic parameters on FDG PET/CT for lymph node metastasis in patients with cN2 non-small cell lung cancer. Reviewed International journal

Keita Nakanishi, Shota Nakamura, Tomoshi Sugiyama, Yuka Kadomatsu, Harushi Ueno, Masaki Goto, Naoki Ozeki, Takayuki Fukui, Shingo Iwano, Toyofumi Fengshi Chen-Yoshikawa

BMC cancer Vol. 21 ( 1 ) page： 983 - 983 2021.9

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

BACKGROUND: The aim of this study was to assess the diagnostic utility of metabolic parameters on fluorine-18-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET)/computed tomography (CT) for predicting lymph node (LN) metastasis in patients with cN2 non-small cell lung cancer (NSCLC). METHODS: We retrospectively reviewed patients who underwent surgery for cN2 NSCLC between 2007 and 2020. Those who had clinically diagnosed positive hilar and mediastinal LNs by routine CT and PET/CT imaging were investigated. To measure the metabolic parameters of LNs, the data according to maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and LN-to-primary tumor ratio of SUVmax (LPR) were examined. The diagnosis of each retrieved LN was confirmed based on histopathological examination of surgical tissue specimens. Receiver operating characteristics (ROC) curves with area under the curve (AUC) calculations and multivariate analysis by logistic regression were performed. RESULTS: Forty-five patients with 84 clinically diagnosed positive hilar or mediastinal LNs were enrolled in the present study. Of the 84 LNs, 63 LNs were pathologically proven as positive (75%). The SUVmax, MTV, TLG, and LPR of LN metastasis were significantly higher than those of benign nodes. In the ROC analysis, the AUC value of LPR [AUC, 0.776; 95% confidence interval (CI), 0.640-0.913] was higher than that of LN SUVmax (AUC, 0.753; 95% CI, 0.626-0.880) or LN TLG3.5 (AUC, 0.746; 95% CI, 0.607-0.885). Using the optimal LPR cutoff value of 0.47, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.1, 66.7, 88.3, 58.3, and 79.8%, respectively. Multivariate analysis by logistic regression showed that LPR was an independent predictor for LN metastasis (odds ratio, 6.45; 95% CI, 1.785-23.301; P = 0.004). In the subgroup analysis of adenocarcinoma patients (n = 18; 32 LNs), TLG3.5 was a better predictor (AUC, 0.816; 95% CI, 0.639-0.985) than LPR (AUC, 0.792; 95% CI, 0.599-0.986) or LN SUVmax (AUC, 0.792; 95% CI, 0.625-0.959). CONCLUSIONS: Our findings suggest that LPR on FDG-PET is a useful predictor for LN metastasis in patients with cN2 NSCLC. TLG can be a good predictor for LN metastasis in patients with adenocarcinoma.

DOI： 10.1186/s12885-021-08688-6

【COVID-19肺炎と肺疾患AI開発のフロントライン】COVID-19肺炎におけるAI研究の動向および問題点について

伊藤倫太郎, 岩野信吾, 長縄慎二

医用画像情報学会雑誌 Vol. 38 ( 2 ) page： 32 - 40 2021.7

Language：Japanese Publisher：医用画像情報学会

COVID-19が世界中に広まり、COVID-19肺炎の診断に胸部CTや胸部単純X線の有用性が報告され、この画像所見を用いたAI開発が初期の段階から積極的に行われた。高性能なAIが多数存在するが、臨床において用いる際には注意すべき点が複数存在する。COVID-19肺炎に対して開発・使用された画像診断に関連するAI研究について、PubMedに2020年12月までに登録されたものを抽出しレビューを行った。

cN2非小細胞肺癌のリンパ節転移に対するFDG PET/CTでの代謝パラメーターの診断的有用性に関する検討

仲西慶太, 矢澤まり, 坪内秀樹, 杉山燈人, 門松由佳, 上野陽史, 後藤真輝, 尾関直樹, 中村彰太, 福井高幸, 岩野信吾, 芳川豊史

日本外科学会定期学術集会抄録集 Vol. 121回 page： PS - 8 2021.4

Factors associated with changes in the 12-m stair-climbing time after lung lobectomy. Reviewed

Naoki Ozeki, Takayuki Fukui, Shingo Iwano, Shuhei Hakiri, Shota Nakamura, Koji Kawaguchi, Yota Mizuno, Takayuki Inoue, Motoki Nagaya, Toyofumi Fengshi Chen-Yoshikawa

General thoracic and cardiovascular surgery Vol. 69 ( 2 ) page： 282 - 289 2021.2

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

OBJECTIVE: Postoperative loss-of-exercise capacity is one of the main concerns for patients undergoing lung cancer surgery. This study was designed to identify the factors associated with loss-of-exercise capacity after lobectomy, using an easy surrogate measure: the 12-m stair-climbing time (SCt). METHODS: Ninety-eight patients undergoing lobectomy for suspected stage I lung cancer were prospectively enrolled. SCt and pulmonary function test were evaluated preoperatively as baseline and at 6 months postoperatively. At 6 months postoperatively, 20 patients dropped out. Loss-of-exercise capacity was defined as at least a 3.3% decline (lower quartile) in the estimated maximal oxygen uptake (VO2t: 43.06 - 0.4 × SCt). Factors associated with loss-of-exercise capacity were analyzed. RESULTS: Median (interquartile range) baseline SCt was 31.5 (28.2-36.7) s. Baseline SCt was not significantly associated with complications. At 6 months postoperatively, SCt increased by + 4.4 (+ 3.2, + 6.8) s in patients with loss-of-exercise capacity. Sex, smoking status, lobe, procedure, and forced expiratory volume in 1 s showed no significant association with loss-of-exercise capacity. In the multivariable logistic regression, older age (≥ 73 years) (odds ratio: 5.25, 95% confidence interval: 1.50-18.43, p = 0.010) and lower baseline diffusing capacity of the lung for carbon monoxide (< 75%) (odds ratio: 9.23, 95% confidence interval: 1.94-43.93, p = 0.005) were significantly associated with loss-of-exercise capacity. CONCLUSION: Age and the baseline diffusing capacity of the lung for carbon monoxide were identified as significant variables associated with variation of exercise capacity after lung cancer surgery, using pre- and postoperative SCt.

DOI： 10.1007/s11748-020-01458-4

Shingo Iwano, Shinichiro Kamiya, Rintaro Ito, Shota Nakamura, Shinji Naganawa

Cancer imaging : the official publication of the International Cancer Imaging Society Vol. 21 ( 1 ) page： 7 - 7 2021.1

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

BACKGROUND: To investigate the correlation between iodine-related attenuation in contrast-enhanced dual-energy computed tomography (DE-CT) and the postoperative prognosis of surgically resected solid-type small-sized lung cancers. METHODS: We retrospectively reviewed the DE-CT findings and postoperative course of solid-type lung cancers ≤3 cm in diameter. After injection of iodinated contrast media, arterial phases were scanned using 140-kVp and 80-kVp tube voltages. Three-dimensional iodine-related attenuation (3D-IRA) of primary tumors at the arterial phase was computed using the "lung nodule" application software. The corrected 3D-IRA normalized to the patient's body weight and contrast medium concentration was then calculated. RESULTS: A total of 120 resected solid-type lung cancers ≤3 cm in diameter were selected for analysis (82 males and 38 females; mean age, 67 years). During the observation period (median, 47 months), 32 patients showed postoperative recurrence. Recurrent tumors had significantly lower 3D-IRA and corrected 3D-IRA at early phase compared to non-recurrent tumors (p = 0.046 and p = 0.027, respectively). The area under the receiver operating characteristic curve for postoperative recurrence was 0.624 for the corrected 3D-IRA at early phase (p = 0.025), and the cutoff value was 5.88. Kaplan-Meier curves for disease-free survival indicated that patients showing tumors with 3D-IRA > 5.88 had a significantly better prognosis than those with tumors showing 3D-IRA < 5.88 (p = 0.017). CONCLUSIONS: The 3D-IRA of small-sized solid-type lung cancers on contrast-enhanced DE-CT was significantly associated with postoperative prognosis, and low 3D-IRA tumors showed a higher TNM stage and a significantly poorer prognosis.

DOI： 10.1186/s40644-020-00368-1

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

Rintaro Ito, Shingo Iwano, Shinji Naganawa

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

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

Bronchial wall thickening is associated with severity of chronic rhinosinusitis

Suguru Majima, Keiko Wakahara, Tomoko Nishio, Naoki Nishio, Masaaki Teranishi, Shingo Iwano, Akihiro Hirakawa, Naozumi Hashimoto, Michihiko Sone, Yoshinori Hasegawa

Respiratory Medicine Vol. 170 page： 106024 2020.8

Language：English Publishing type：Research paper (scientific journal) Publisher：W.B. Saunders Ltd

Background: Though the relationship between chronic rhinosinusitis (CRS) and lower airway diseases is well recognized, the impact of CRS on bronchial wall structure has not been elucidated. Here, we evaluated the bronchial wall structure of CRS patients with or without diagnosed airway diseases by three-dimensional computed tomography (3D-CT). Methods: Subjects who underwent both chest CT and sinus CT within a year were recruited from consecutive medical records. CRS was defined as a Lund-Mackay score (LMS) of over 5 points. Airway dimensions were measured using validated software. Standard blood tests and pulmonary function tests were performed, and their correlation with airway thickness was examined. Results: One-hundred-seventy-two patients were recruited (93 CRS subjects and 79 non-CRS subjects). The bronchial walls of CRS subjects were significantly thicker than those of non-CRS subjects. CRS and asthma were related to bronchial wall thickening by multivariate linear regression analysis adjusted for age, smoking status, and chest symptoms. In addition, LMS was significantly correlated with bronchial wall thickening. Conclusion: Airway walls in CRS subjects were thicker than those in non-CRS subjects and associated with the severity of CRS. These data indicate strong relationship between upper and lower airways regardless of chest symptoms or diagnosed airway diseases.

DOI： 10.1016/j.rmed.2020.106024

Assessment of Severity in Chronic Thromboembolic Pulmonary Hypertension by Quantitative Parameters of Dual-Energy Computed Tomography. International journal

Yoshinori Tsutsumi, Shingo Iwano, Naoki Okumura, Shiro Adachi, Shinji Abe, Takahisa Kondo, Katsuhiko Kato, Shinji Naganawa

Journal of computer assisted tomography Vol. 44 ( 4 ) page： 578 - 585 2020.7

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

OBJECTIVE: The objective of this study was to assess the correlation between dual-energy computed tomography quantitative parameters and hemodynamics in patients with chronic thromboembolic pulmonary hypertension. METHODS: Dual-energy computed tomography of 52 chronic thromboembolic pulmonary hypertension patients were evaluated retrospectively. The mean lung perfused blood volume (lung PBV) and the mean pulmonary artery (PA) enhancement measured at pulmonary parenchymal phase were compared with the hemodynamics by Spearman rank correlation coefficient (rs) and receiver operating characteristic analysis. RESULTS: Lung PBV was correlated with mean pulmonary arterial pressure (rs = 0.47, P < 0.001). Pulmonary artery enhancement was correlated with cardiac index (rs = -0.49, P < 0.001) and pulmonary vascular resistance (rs = 0.48, P < 0.001). The areas under the curves were 0.86 for lung PBV to predict mean pulmonary arterial pressure of >50 mm Hg and 0.86 for PA enhancement to predict pulmonary vascular resistance of >1000 dyne·s/cm. CONCLUSIONS: Lung PBV and PA enhancement could be indicators of hemodynamics.

DOI： 10.1097/RCT.0000000000001052

Well-differentiated fetal adenocarcinoma of the lung: positron emission tomography features and diagnostic difficulties in frozen section analysis-a case report. International journal

Shuhei Hakiri, Takayuki Fukui, Hideki Tsubouchi, Ayako Sakakibara, Shingo Iwano, Toyofumi F Chen-Yoshikawa

Surgical case reports Vol. 6 ( 1 ) page： 152 - 152 2020.6

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

BACKGROUND: Well-differentiated fetal adenocarcinoma (WDFA) of the lung is a rare disease that resembles fetal lung tubules. Most of previous reports concerning WDFA have focused on histological features, while there are few reports describing radiological features. In addition, there are no reports evaluating the difficulty of intraoperative diagnosis of WDFA with frozen section. We report a case of WDFA and review the radiological features of WDFA including the findings of F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) and assess the difficulty of intraoperative diagnosis with frozen section. CASE PRESENTATION: A chest radiography performed in a 20-year-old female revealed a mass in the hilum of the right lung. Computed tomography revealed a well-defined mass measuring 3.5 × 3.0 cm in diameter in the right upper lobe, whereas PET showed a high accumulation of FDG. The most likely diagnosis was clinical T2aN0M0 stage 1B non-small cell lung cancer. A right S3 segmentectomy was performed via thoracotomy, and a benign tumor that was possibly an adenoma was intraoperatively diagnosed based on frozen section analysis. The mass was a solid tumor measuring 2.9 × 2.5 cm in diameter. Microscopically, the tumor comprised abundant glands with single or double layers of nonciliated cells and bronchial structures resembling a fetal lung. Rounded morules of polygonal cells were frequently observed. Immunohistochemistry revealed that nuclei and cytoplasm of the tumor cell were positive for β-catenin. Finally, the postoperative pathological diagnosis was well-differentiated fetal adenocarcinoma of the lung, and completion right upper lobectomy and mediastinal lymph node dissection were conducted 1 month after the initial segmentectomy. No residual tumor or lymph node metastasis was identified, and the final pathological stage was pT1cN0M0 stage 1A3. The patient did not wish to receive any adjuvant therapy. At the 1-year follow-up, no evidence of recurrence was noted. CONCLUSIONS: Here, we report a rare case of well-differentiated fetal adenocarcinoma of the lung that was difficult to diagnose based on radiological evaluations including FDG-PET and intraoperative diagnosis using frozen section analysis.

DOI： 10.1186/s40792-020-00910-0

Psoas muscle mass in patients undergoing lung cancer surgery: a prognostic difference between squamous cell carcinoma and adenocarcinoma Reviewed

Naoki Ozeki, Koji Kawaguchi, Takayuki Fukui, Shota Nakamura, Shuhei Hakiri, Shunsuke Mori, Masaki Goto, Shingo Iwano, Kohei Yokoi, Toyofumi Fengshi Chen-Yoshikawa

International Journal of Clinical Oncology Vol. 25 ( 5 ) page： 876 - 884 2020.5

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

© 2020, Japan Society of Clinical Oncology. Background: Psoas muscle mass is a surrogate marker for sarcopenia: a depletion of skeletal muscle mass. This study was conducted to elucidate the prognostic significance of the psoas muscle index (PMI: cross-sectional area of the bilateral psoas muscle at the umbilical level on computed tomography/height2 [cm2/m2]) in patients undergoing surgery for lung squamous cell carcinoma (SCC) and lung adenocarcinoma (ADC). Methods: One hundred and sixty-five patients with SCC and 556 patients with ADC who underwent R0 resection between 2007 and 2014 were reviewed for analysis. In SCC patients, the mean value (standard deviation) of the PMI was 6.15 (1.49) in men and 4.65 (1.36) in women. Among ADC patients, the PMI was 7.12 (1.60) in men and 5.29 (1.22) in women. Clinicopathological characteristics as well as the survival were evaluated. Results: The PMI was associated with the age, body mass index (BMI), and serum albumin. In the multivariable Cox regression analysis, after adjusting for age, BMI, serum albumin, sex, pathological stage, and diffusing capacity for carbon monoxide, the PMI showed a significant association with the overall survival (OS) and disease-free survival (DFS) in SCC patients (hazard ratios 0.50 and 0.56, 95% confidence intervals 0.39–0.65 and 0.45–0.71, respectively). On the other hand, in ADC patients, the PMI had no impact on the OS or DFS. Conclusions: The PMI was significantly associated with the survival of lung SCC patients, but not of lung ADC patients, suggesting the presence of a previously unidentified relationship between skeletal muscle and lung SCC progression.

DOI： 10.1007/s10147-020-01624-x

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

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

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

病期Iの肺癌切除症例の術後再発における残存慢性呼吸器疾患の影響に関する検討

Reply to "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. 21 ( 3 ) page： E205 - E205 2020.5

橋本直純, 川口晃司, 岩野信吾

肺癌 Vol. 60 ( 2 ) page： 143 - 143 2020.4

【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

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 2020.3

Language：Japanese Publisher：(株)Gakken

＜文献概要＞肺癌の臨床病期分類(TNM分類)は主に画像診断に基づいて行われる.2017年に改訂されたTNM分類では,T因子(サイズ)の診断が複雑になった.病理学的浸潤径に相当する充実成分径の計測はthinsection CTで行うのが基本であるが,3次元CTやPET/CTを利用することで精度の向上が期待できる.

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00235&link_issn=&doc_id=20200408090014&doc_link_id=10.15105%2FGZ.0000001656&url=https%3A%2F%2Fdoi.org%2F10.15105%2FGZ.0000001656&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

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

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

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

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

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

【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

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

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

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

Predictive factors for the outcomes of initial I-131 low-dose ablation therapy to Japanese patients with differentiated thyroid cancer Reviewed

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)

Shinji Ito, Shingo Iwano, Katsuhiko Kato, Shinji Naganawa

Annals of Nuclear Medicine Vol. 32 ( 6 ) page： 418 - 424 2018.7

Language：English Publishing type：Research paper (scientific journal) Publisher：Springer Tokyo

Objective: To identify prognostic factors associated with a low-iodine diet (LID) and the amount of remnant thyroid tissue in Japanese patients with differentiated thyroid cancer (DTC) who received initial I-131 remnant ablation (RAI) using a fixed low dose of I-131 (1110 MBq). Patients and methods: In this prospective study, we enrolled 45 patients. Patients were classified into a self-managed LID group and a strict LID group. We measured the urinary iodine concentration on the day of RAI after patients consumed LID for 2 weeks. Thyroid-stimulating hormone-induced thyroglobulin (Tg) levels and I-131 uptake by the remnant thyroid tissue were also evaluated. A response-evaluation whole-body scan (WBS) was performed 6–8 months after RAI to determine the outcome of the therapy. Results: Post-LID urinary iodine levels of the strict LID group tended to be lower than those of the self-managed LID group. Twenty-five cases (56%) showed absence of uptake, whereas 20 cases (44%) showed residual uptake on the response-evaluation WBS. There were no significant differences between “absence” and “residual” groups in urinary iodine concentrations and Tg levels (p = 0.253 and p = 0.234, respectively). However, significant differences were observed in I-131 uptake by the thyroid bed (p = 0.035). Conclusions: For patients following the current Japanese method of a 2-week LID, the urinary iodine concentration was not a predictive factor for the successful outcome of RAI. In contrast, low I-131 uptake by the thyroid bed, revealed by the scintigram after RAI, may serve as a favorable predictive factor.

DOI： 10.1007/s12149-018-1261-0

Computer-aided Volumetry of Part-Solid Lung Cancers by Using CT: Solid Component Size Predicts Prognosis. Reviewed International journal

Shinichiro Kamiya, Shingo Iwano, Hiroyasu Umakoshi, Rintaro Ito, Hironori Shimamoto, Shota Nakamura, Shinji Naganawa

Radiology Vol. 287 ( 3 ) page： 1030 - 1040 2018.6

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

Purpose To investigate the relationship between the postoperative prognosis of patients with part-solid non-small cell lung cancer and the solid component size acquired by using three-dimensional (3D) volumetry software on multidetector computed tomographic (CT) images. Materials and Methods A retrospective study by using preoperative multidetector CT data with 0.5-mm section thickness, clinical records, and pathologic reports of 96 patients with primary subsolid non-small cell lung cancer (47 men and 49 women; mean age ± standard deviation, 66 years ± 8) were reviewed. Two radiologists measured the two-dimensional (2D) maximal solid size of each nodule on an axial image (hereafter, 2D MSSA), the 3D maximal solid size on multiplanar reconstructed images (hereafter, 3D MSSMPR), and the 3D solid volume of greater than 0 HU (hereafter, 3D SV0HU) within each nodule. The correlations between the postoperative recurrence and the effects of clinical and pathologic characteristics, 2D MSSA, 3D MSSMPR, and 3D SV0HU as prognostic imaging biomarkers were assessed by using a Cox proportional hazards model. Results For the prediction of postoperative recurrence, the area under the receiver operating characteristics curve was 0.796 (95% confidence interval: 0.692, 0.900) for 2D MSSA, 0.776 (95% confidence interval: 0.667, 0.886) for 3D MSSMPR, and 0.835 (95% confidence interval: 0.749, 0.922) for 3D SV0HU. The optimal cutoff value for 3D SV0HU for predicting tumor recurrence was 0.54 cm3, with a sensitivity of 0.933 (95% confidence interval: 0.679, 0.998) and a specificity of 0.716 (95% confidence interval: 0.605, 0.811) for the recurrence. Significant predictive factors for disease-free survival were 3D SV0HU greater than or equal to 0.54 cm3 (hazard ratio, 6.61; P = .001) and lymphatic and/or vascular invasion derived from histopathologic analysis (hazard ratio, 2.96; P = .040). Conclusion The measurement of 3D SV0HU predicted the postoperative prognosis of patients with part-solid lung cancer more accurately than did 2D MSSA and 3D MSSMPR. © RSNA, 2018.

DOI： 10.1148/radiol.2018172319

Thin-section computed tomography-determined usual interstitial pneumonia pattern affects the decision-making process for resection in newly diagnosed lung cancer patients: a retrospective study. Reviewed

胸壁並行断面CTを用いた間質性肺炎の経時的評価

馬越弘泰, 岩野信吾, 伊藤倫太郎, 島本宏矩, 長縄慎二

Japanese Journal of Radiology Vol. 36 ( Suppl. ) page： 19 - 19 2018.2

非小細胞肺癌の局所浸潤性の予測に関する造影dual energy CTとFDG-PET/CTの比較

伊藤倫太郎, 岩野信吾, 島本宏矩, 馬越弘泰, 伊藤信嗣, 長縄慎二, 加藤克彦

Japanese Journal of Radiology Vol. 36 ( Suppl. ) page： 20 - 20 2018.2

Hashimoto N, Ando A, Iwano S, Sakamoto K, Okachi S, Matsuzaki A, Okada Y, Wakai K, Yokoi K, Hasegawa Y

BMC pulmonary medicine Vol. 18 ( 1 ) page： 2 2018.1

FDG PET/CT Overcomes Discordance Between Clinical and Pathologic TNM Classification of Small-size Primary Lung Cancer: Influence on Postoperative Prognosis. Reviewed International journal

Hiroyasu Umakoshi, Shingo Iwano, Kohei Yokoi, Shinji Ito, Rintaro Ito, Koji Kawaguchi, Takayuki Fukui, Shinji Naganawa

Clinical lung cancer Vol. 19 ( 1 ) page： E37 - E45 2018.1

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

INTRODUCTION: We aimed to determine the concordance between the clinical stage (c-stage) and pathologic stage (p-stage) for patients with small-size lung cancer. Additionally we searched for prognostic factors other than the TNM stage. PATIENTS AND METHODS: We retrospectively reviewed the preoperative multidetector computed tomography (CT) and positron emission tomography/CT reports, surgical records, and pathologic reports of patients with primary lung cancer ≤ 3 cm. The Union for International Cancer Control TNM seventh edition classification of c-stage and p-stage were compared. The tumors were classified into multiple subgroups by concordance or discordance between the c-stage and p-stage. Disease-free survival (DFS) was assessed using survival analysis to assess the tumor characteristics that were predictive of prognosis. RESULTS: A total of 289 surgically resected primary lung cancers were evaluated. The concordance between c-stage and p-stage was 65.4%, with moderate reproducibility (kappa coefficient, 0.467). The upstaging rate from c-stage I to p-stage II-IV was 9.4%, and these patients had significantly worse DFS than those with a concordant stage I classification (P < .001). The main reason for upstaging was an underestimation of metastases to the hilar lymph nodes (n = 7) or mediastinal lymph nodes (n = 11). A multivariate Cox proportional hazards model showed that the significant predictive factors for DFS were p-stage (hazard ratio, 1.342; P = .003) and maximum standardized uptake value on positron emission tomography/CT (hazard ratio, 12.162; P = .001). CONCLUSION: The concordance rate between c-stage and p-stage for small primary lung cancers had moderate reproducibility. Discordance between c-stage I and p-stage II-IV significantly affected DFS. The maximum standardized uptake value of the primary lesion was an independent prognostic factor, and combining it with c-stage might improve the prediction of therapeutic outcomes.

DOI： 10.1016/j.cllc.2017.05.021

A comparative analysis of dual-phase dual-energy CT and FDG-PET/CT for the prediction of histopathological invasiveness of non-small cell lung cancer. Reviewed International journal

Rintaro Ito, Shingo Iwano, Hironori Shimamoto, Hiroyasu Umakoshi, Koji Kawaguchi, Shinji Ito, Katsuhiko Kato, Shinji Naganawa

European journal of radiology Vol. 95 page： 186 - 191 2017.10

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

PURPOSE: To compare dual-phase dual-energy CT (DE-CT) with FDG-PET/CT for predicting histopathological locoregional invasiveness of non-small cell lung cancers (NSCLCs). MATERIALS AND METHODS: We selected 63 consecutive patients with NSCLC lesions (37 males, 26 females; age range, 44-85 years; mean age, 69 years) who were evaluated preoperatively by both DE-CT and PET/CT at our institution. Postoperative microscopic invasiveness (lymphatic permeation, vascular invasion, and/or pleural involvement) was reviewed, and we defined locoregionally invasive tumors as those that had at least one positive finding of microscopic invasiveness. DE-CT scanning in the arterial and delayed phases was performed after injection of iodinated contrast media using 140-kVp and 80-kVp tube voltages. Three-dimensional iodine-related attenuation of primary tumors in the arterial and delayed phases was quantified automatically using "syngo Dual Energy Lung Nodules" application software, and the ratio of arterial phase to delayed phase enhancement (A/D ratio) was calculated. The A/D ratio and SUVmax on PET/CT were evaluated with respect to postoperative invasiveness by univariate logistic regression analysis. RESULTS: The A/D ratio was significantly correlated with lymphatic permeation, vascular invasion, and pleural involvement (p=0.011, p=0.021, and p=0.010, respectively). In contrast, the SUVmax was significantly correlated with pleural involvement (p=0.020) but not with lymphatic permeation or vascular invasion (p=0.088 and p=0.100, respectively). In the subgroup of patients with lesion diameters ≤2cm, the A/D ratio was significantly correlated with locoregional invasiveness (p=0.040), while the SUVmax was not (p=0.121). CONCLUSION: For the prediction of microscopic invasiveness of NSCLCs, the diagnostic performance of dual-phase DE-CT may be comparable to that of FDG-PET/CT.

DOI： 10.1016/j.ejrad.2017.08.010

Automated mediastinal lymph node detection from CT volumes based on intensity targeted radial structure tensor analysis Reviewed

Hirohisa Oda, Kanwal K. Bhatia, Masahiro Oda, Takayuki Kitasaka, Shingo Iwano, Hirotoshi Homma, Hirotsugu Takabatake, Masaki Mori, Hiroshi Natori, Julia A. Schnabel, Kensaku Mori

Journal of Medical Imaging Vol. 4 ( 4 ) page： 044502 2017.10

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

This paper presents a local intensity structure analysis based on an intensity targeted radial structure tensor (ITRST) and the blob-like structure enhancement filter based on it (ITRST filter) for the mediastinal lymph node detection algorithm from chest computed tomography (CT) volumes. Although the filter based on radial structure tensor analysis (RST filter) based on conventional RST analysis can be utilized to detect lymph nodes, some lymph nodes adjacent to regions with extremely high or low intensities cannot be detected. Therefore, we propose the ITRST filter, which integrates the prior knowledge on detection target intensity range into the RST filter. Our lymph node detection algorithm consists of two steps: (1) obtaining candidate regions using the ITRST filter and (2) removing false positives (FPs) using the support vector machine classifier. We evaluated lymph node detection performance of the ITRST filter on 47 contrast-enhanced chest CT volumes and compared it with the RST and Hessian filters. The detection rate of the ITRST filter was 84.2% with 9.1 FPs/volume for lymph nodes whose short axis was at least 10 mm, which outperformed the RST and Hessian filters.

DOI： 10.1117/1.JMI.4.4.044502

Quantitative evaluation of interstitial pneumonia using 3D-curved high-resolution CT imaging parallel to the chest wall: A pilot study. Reviewed International journal

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

PloS one Vol. 12 ( 9 ) page： e0185532 2017.9

Language：English

OBJECTIVES: To quantify the imaging findings of patients with interstitial pneumonia (IP) and emphysema using three-dimensional curved high-resolution computed tomography (3D-cHRCT) at a constant depth from the chest wall, and compare the results to visual assessment of IP and each patient's diffusing capacity of the lungs for carbon monoxide (DLco). METHODS: We retrospectively reviewed the axial CT findings and pulmonary function test results of 95 patients with lung cancer (72 men and 23 women, aged 45-84 years) with or without IP, as follows: non-IP (n = 47), mild IP (n = 31), and moderate IP (n = 17). The 3D-cHRCT images of the lung at a 1-cm depth from the chest wall were reconstructed automatically using original software; total area (TA), high-attenuation area (HAA) >-500 HU, and low-attenuation area (LAA) <-950 HU were calculated on a workstation. The %HAA and %LAA were calculated as follows: [Formula: see text], and [Formula: see text]. RESULTS: The %HAA and %LAA respective values were 3.2±0.9 and 27.7±8.2, 3.9±1.2 and 27.6±5.9, and 6.9±2.2 and 25.4±8.7 in non-IP, mild IP, and moderate IP patients, respectively. There were significant differences in %HAA between the 3 groups of patients (P<0.001), but no differences in %LAA (P = 0.558). Multiple linear regression analysis revealed that %HAA and %LAA were negatively correlated with predicted DLco (standard partial regression coefficient [b*] = -0.453, P<0.001; b* = -0.447, P<0.001, respectively). CONCLUSIONS: The %HAA and %LAA values computed using 3D-cHRCT were significantly correlated with DLco and may be important quantitative parameters for both IP and emphysema.

DOI： 10.1371/journal.pone.0185532

FDG-PETによる非小細胞肺癌の予後予測因子の検討 SUVmaxと体積を考慮した指標の比較

Dual Energy CTによる小型肺癌の造影評価

島本宏矩, 岩野信吾, 馬越弘泰, 伊藤倫太郎, 長縄慎二

Japanese Journal of Radiology Vol. 35 ( Suppl. ) page： 34 - 34 2017.2

伊藤信嗣, 岩野信吾, 伊藤倫太郎, 長縄慎二, 加藤克彦

核医学 Vol. 54 ( 1 ) page： 565 - 565 2017.2

ドパミントランスポータシンチグラフィにおける解析ソフトの有用性に関する研究

松澤伸一郎, 加藤克彦, 国本啓太, 本田将之, 椋本竜斗, 小田川哲郎, 阿部真治, 藤田尚利, 櫻木庸博, 伊藤信嗣, 伊藤倫太郎, 岩野信吾, 長縄慎二

核医学 Vol. 54 ( 1 ) page： 663 - 663 2017.2

胸壁並行断面CTを用いた間質性肺炎の定量的評価

馬越弘泰, 岩野信吾, 伊藤倫太郎, 長縄慎二

Japanese Journal of Radiology Vol. 35 ( Suppl. ) page： 34 - 34 2017.2

Thoracic Temporal Subtraction Three Dimensional Computed Tomography (3D-CT): Screening for Vertebral Metastases of Primary Lung Cancers. Reviewed International journal

Shingo Iwano, Rintaro Ito, Hiroyasu Umakoshi, Takatoshi Karino, Tsutomu Inoue, Yuanzhong Li, Shinji Naganawa

PloS one Vol. 12 ( 1 ) page： e0170309 2017.1

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

PURPOSE: We developed an original, computer-aided diagnosis (CAD) software that subtracts the initial thoracic vertebral three-dimensional computed tomography (3D-CT) image from the follow-up 3D-CT image. The aim of this study was to investigate the efficacy of this CAD software during screening for vertebral metastases on follow-up CT images of primary lung cancer patients. MATERIALS AND METHODS: The interpretation experiment included 30 sets of follow-up CT scans in primary lung cancer patients and was performed by two readers (readers A and B), who each had 2.5 years' experience reading CT images. In 395 vertebrae from C6 to L3, 46 vertebral metastases were identified as follows: osteolytic metastases (n = 17), osteoblastic metastases (n = 14), combined osteolytic and osteoblastic metastases (n = 6), and pathological fractures (n = 9). Thirty-six lesions were in the anterior component (vertebral body), and 10 lesions were in the posterior component (vertebral arch, transverse process, and spinous process). The area under the curve (AUC) by receiver operating characteristic (ROC) curve analysis and the sensitivity and specificity for detecting vertebral metastases were compared with and without CAD for each observer. RESULTS: Reader A detected 47 abnormalities on CT images without CAD, and 33 of them were true-positive metastatic lesions. Using CAD, reader A detected 57 abnormalities, and 38 were true positives. The sensitivity increased from 0.717 to 0.826, and on ROC curve analysis, AUC with CAD was significantly higher than that without CAD (0.849 vs. 0.902, p = 0.021). Reader B detected 40 abnormalities on CT images without CAD, and 36 of them were true-positive metastatic lesions. Using CAD, reader B detected 44 abnormalities, and 39 were true positives. The sensitivity increased from 0.783 to 0.848, and AUC with CAD was nonsignificantly higher than that without CAD (0.889 vs. 0.910, p = 0.341). Both readers detected more osteolytic and osteoblastic metastases with CAD than without CAD. CONCLUSION: Our temporal 3D-CT subtraction CAD software easily detected vertebral metastases on the follow-up CT images of lung cancer patients regardless of the osteolytic or osteoblastic nature of the lesions.

DOI： 10.1371/journal.pone.0170309

Hessian-assisted supervoxel: Structure-oriented voxel clustering and application to mediastinal lymph node detection from CT volumes Reviewed

Hirohisa Oda, Kanwal K. Bhatia, Masahiro Oda, Takayuki Kitasaka, Shingo Iwano, Hirotoshi Homma, Hirotsugu Takabatake, Masaki Mori, Hiroshi Natori, Julia A. Schnabel, Kensaku Mori

Progress in Biomedical Optics and Imaging - Proceedings of SPIE Vol. 10134 2017

Language：English Publishing type：Research paper (international conference proceedings) Publisher：SPIE

In this paper, we propose a novel supervoxel segmentation method designed for mediastinal lymph node by embedding Hessian-based feature extraction. Starting from a popular supervoxel segmentation method, SLIC, which computes supervoxels by minimising differences of intensity and distance, we overcome this method's limitation of merging neighboring regions with similar intensity by introducing Hessian-based feature analysis into the supervoxel formation. We call this structure-oriented voxel clustering, which allows more accurate division into distinct regions having blob-, line- or sheet-like structures. This way, different tissue types in chest CT volumes can be segmented individually, even if neighboring tissues have similar intensity or are of non- spherical extent. We demonstrate the performance of the Hessian-assisted supervoxel technique by applying it to mediastinal lymph node detection in 47 chest CT volumes, resulting in false positive reductions from lymph node candidate regions. 89 % of lymph nodes whose short axis is at least 10 mm could be detected with 5.9 false positives per case using our method, compared to our previous method having 83 % of detection rate with 6.4 false positives per case.

DOI： 10.1117/12.2254782

Visualization of Middle Ear Ossicles in Elder Subjects with Ultra-short Echo Time MR Imaging Reviewed

Planning video-assisted thoracic surgery segmentectomy using three dimensional computed tomography angiography and bronchography with a virtual safety margin. Reviewed

Iwano S

Journal of visualized surgery Vol. 3 page： 82 2017

Shinji Naganawa, Toshiki Nakane, Hisashi Kawai, Toshiaki Taoka, Kojiro Suzuki, Shingo Iwano, Hiroko Satake, David Grodzki

MAGNETIC RESONANCE IN MEDICAL SCIENCES Vol. 16 ( 2 ) page： 93 - 97 2017

Language：English Publishing type：Research paper (scientific journal) Publisher：JPN SOC MAGNETIC RESONANCE MEDICINE

Purpose: To evaluate the visualization of middle ear ossicles by ultra-short echo time magnetic resonance (MR) imaging at 3T in subjects over 50 years old.
Materials and Methods: Sixty ears from 30 elder patients that underwent surgical or interventional treatment for neurovascular diseases were included (ages: 50-82, median age: 65; 10 men, 20 women). Patients received follow-up MR imaging including routine T1-and T2-weighted images, time-of-flight MR angiography, and ultra-short echo time imaging (PETRA, pointwise encoding time reduction with radial acquisition). All patients underwent computed tomography (CT) angiography before treatment. Thin-section source CT images were correlated with PETRA images. Scan parameters for PETRA were: TR 3.13, TE 0.07, flip angle 6 degrees, 0.83 x 0.83 x 0.83 mm resolution, 3 min 43 s scan time. Two radiologists retrospectively evaluated the visibility of each ossicular structure as positive or negative using PETRA images. The structures evaluated included the head of the malleus, manubrium of the malleus, body of the incus, long process of the incus, and the stapes. Signal intensity of the ossicles was classified as: between labyrinthine fluid and air, similar to labyrinthine fluid, between labyrinthine fluid and cerebellar parenchyma, or higher than cerebellar parenchyma.
Results: In all ears, the body of the incus was visible. The head of the malleus was visualized in 36/60 ears. The manubrium of the malleus and long process of the incus was visualized in 1/60 and 4/60 ears, respectively. The stapes were not visualized in any ear. Signal intensity of the visible structures was between labyrinthine fluid and air in all ears.
Conclusion: The body of the incus was consistently visualized with intensity between air and labyrinthine fluid on PETRA images in aged subjects. Poor visualization of the manubrium of the malleus, long process of the incus, and the stapes limits clinical significance of middle ear imaging with current PETRA methods.

DOI： 10.2463/mrms.mp.2015-0171

Evaluation of locoregional invasiveness of small-sized non-small cell lung cancers by enhanced dual-energy computed tomography Reviewed

Shimamoto H, Iwano S, Umakoshi H, Kawaguchi K, Naganawa S

Cancer Imaging Vol. 16 ( 1 ) page： 18 2016.7

Respiratory mechanics measured by forced oscillation technique in rheumatoid arthritis-related pulmonary abnormalities: frequency-dependence, heterogeneity and effects of smoking Reviewed

Sokai R, Ito S, Iwano S, Uchida A, Aso H, Kondo M, Ishiguro N, Kojima T, Hasegawa, Y

Springerplus Vol. 5 page： 335 2016.4

Correlation between FDG-PET/CT findings and solid type non-small cell cancer prognostic factors: are there differences between adenocarcinoma and squamous cell carcinoma? Reviewed

Ito R, Iwano S, Kishimoto M, Ito S, Kato K, Naganawa S.

Ann Nucl Med Vol. 29 ( 10 ) page： 897-905 2015.9

Evaluation of lung cancer by enhanced dual-energy CT: Association between three-dimensional iodine concentration and tumor differentiation. Reviewed

Iwano S, Ito R, Umakoshi H, Ito S, Naganawa S

Br J Radiol Vol. 88 page： 20150224 2015.9

The contact length between the tumor contour and the lung on computed tomography is a risk factor for pleural recurrence after complete resection of thymoma. Reviewed

Kato T, Iwano S, Taniguchi T, Kawaguchi K, Fukui T, Ishiguro F, Fukumoto K, Nakamura S, Hirakawa A, Yokoi K.

Gen Thorac Cardiovasc Surg Vol. 63 ( 6 ) page： 343-348 2015.2

Evaluation of emphysema using three-dimensional computed tomography: association with postoperative complications in lung cancer patients Reviewed

Kawakami K, Iwano S, Hashimoto N, Hasegawa Y, Naganawa S.

Nagoya J Med Sci Vol. 77 ( 1-2 ) page： 113-122 2015.2

Lobar analysis of collapsibility indices to assess functional lung volumes in COPD patients. Reviewed

Kitano M, Iwano S, Hashimoto N, Matsuo K, Hasegawa Y, Naganawa S.

Int J Chron Obstruct Pulmon Dis. Vol. 9 page： 1347-1356 2014.12

Prognostic evaluations of small size lung cancers by 18F-FDG PET/CT and thin-section CT. Reviewed

Kishimoto M, Iwano S, Ito S, Kato K, Ito R, Naganawa S

Lung Cancer Vol. 86 ( 2 ) page： 180-184 2014.9

Evaluation of 11C-choline PET/CT for primary diagnosis and staging of urothelial carcinoma of the upper urinary tract: a pilot study. Reviewed

Sassa N, Kato K, Abe S, Iwano S, Ito S, Ikeda M, Shimamoto K, Yamamoto S, Yamamoto T, Gotoh M, Naganawa S.

Eur J Nucl Med Mol Imaging Vol. 41 ( 12 ) page： 2232-2241 2014.8

Therapeutic surgery without a definitive diagnosis can be an option in selected patients with suspected lung cancer. Reviewed

Ozeki N, Iwano S, Taniguchi T, Kawaguchi K, Fukui T, Ishiguro F, Fukumoto K, Nakamura S, Hirakawa A, Yokoi K.

Interact Cardiovasc Thorac Surg Vol. 19 ( 5 ) page： 830-837 2014.7

Prediction of pathologic prognostic factors in patients with lung adenocarcinomas: comparison of thin-section computed tomography and positron emission tomography/computed tomography. Reviewed

Iwano S, Kishimoto M, Ito S, Kato K, Ito R, Naganawa S

Cancer Imaging Vol. 22 ( 14 ) page： 3 2014.4

Clinical impact of prevalence and severity of COPD on the decision-making process for therapeutic management of lung cancer patients. Reviewed

Hashimoto N, Matsuzaki A, Okada Y, Imai N, Iwano S, Wakai K, Imaizumi K, Yokoi K, Hasegawa Y

BMC Pulm Med Vol. 5 ( 14 ) page： 14 2014.2

Comparison of 18F-fluoride PET/CT, 18F-FDG PET/CT and bone scintigraphy (planar and SPECT) in detection of bone metastases of differentiated thyroid cancer: a pilot study. Reviewed

Ota N, Kato K, Iwano S, Ito S, Abe S, Fujita N, Yamashiro K, Yamamoto S, Naganawa S.

Br J Radiol Vol. 87 ( 1034 ) page： 20130444 2014.1

Doubling time calculations for lung cancer by three-dimensional computer-aided volumetry: effects of inter-observer differences and nodule characteristics Reviewed

Koike, W. Iwano, S. Matsuo, K. Kitano, M. Kawakami, K. Naganawa, S.

J Med Imaging Radiat Oncol Vol. 58 ( 1 ) page： 82-8 2013.10

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

INTRODUCTION: The purpose of this study was to investigate doubling time (DT) differences among solid, part-solid (PS) and non-solid (NS) types of lung cancers. We also compared inter-observer differences in size measurements between diameter and three-dimensional (3D) volume measurements of lung cancers, including PS- and NS-type nodules, using 3D computer-aided volumetry (3D-CAV). METHODS: The long-axis diameters and 3D volumes of lung tumours were measured using CAV by two chest radiologists for 71 consecutive patients with peripheral lung cancer who underwent at least two CT examinations before surgical resection. We evaluated the inter-observer variability for the ratio of diameter change (RCdiameter) and volume change (RCvolume), which were based on two CT images obtained at different times prior to resection. Inter-observer agreement was evaluated by Bland-Altman plots. Based on the volumes obtained from 3D-CAV, we calculated the DTs and compared DT differences between solid, PS and NS types of lung tumours. RESULTS: The inter-observer Spearman's rank correlation coefficients were 0.87 for RCvolume and 0.64 for RCdiameter (p < 0.001). For all internal appearance types, the rs values for RCvolume were greater than those for RCdiameter. The median DT values for solid, PS and NS were 278, 347 and 584 days, respectively. NS- and PS-type tumours had significantly longer DTs (p = 0.024; by Spearman's rank correlation coefficient). CONCLUSIONS: DT determinations using 3D-CAV had good correlations with the internal appearances of lung cancers. Lung tumour volume measurements by 3D-CAV exhibited better inter-observer correlations than did diameter measurements.

DOI： 10.1111/1754-9485.12128