研究者詳細 - 田岡　俊昭

論文 - 田岡　俊昭

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Association of MRI Indices of Glymphatic System With Amyloid Deposition and Cognition in Mild Cognitive Impairment and Alzheimer Disease 査読有り国際誌 Open Access

Kamagata, K; Andica, C; Takabayashi, K; Saito, Y; Taoka, T; Nozaki, H; Kikuta, J; Fujita, S; Hagiwara, A; Kamiya, K; Wada, A; Akashi, T; Sano, K; Nishizawa, M; Hori, M; Naganawa, S; Aoki, S

NEUROLOGY 99 巻 ( 24 ) 頁： E2648 - E2660 2022年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Neurology

Background and Objectives The glymphatic system is a whole-brain perivascular network, which promotes CSF/interstitial fluid exchange. Alterations to this system may play a pivotal role in amyloid β (Aβ) accumulation. However, its involvement in Alzheimer disease (AD) pathogenesis is not fully understood. Here, we investigated the changes in noninvasive MRI measurements related to the perivascular network in patients with mild cognitive impairment (MCI) and AD. Additionally, we explored the associations of MRI measures with neuropsychological score, PET standardized uptake value ratio (SUVR), and Aβ deposition. Methods MRI measures, including perivascular space (PVS) volume fraction (PVSVF), fractional volume of free water in white matter (FW-WM), and index of diffusivity along the perivascular space (ALPS index) of patients with MCI, those with AD, and healthy controls from the Alzheimer's Disease Neuroimaging Initiative database were compared. MRI measures were also correlated with the levels of CSF biomarkers, PET SUVR, and cognitive score in the combined subcohort of patients with MCI and AD. Statistical analyses were performed with age, sex, years of education, and APOE status as confounding factors. Results In total, 36 patients with AD, 44 patients with MCI, and 31 healthy controls were analyzed. Patients with AD had significantly higher total, WM, and basal ganglia PVSVF (Cohen d = 1.15-1.48; p < 0.001) and FW-WM (Cohen d = 0.73; p < 0.05) and a lower ALPS index (Cohen d = 0.63; p < 0.05) than healthy controls. Meanwhile, the MCI group only showed significantly higher total (Cohen d = 0.99; p < 0.05) and WM (Cohen d = 0.91; p < 0.05) PVSVF. Low ALPS index was associated with lower CSF Aβ42 (rs = 0.41, pfdr = 0.026), FDG-PET uptake (rs = 0.54, pfdr < 0.001), and worse multiple cognitive domain deficits. High FW-WM was also associated with lower CSF Aβ42 (rs = −0.47, pfdr = 0.021) and worse cognitive performances. Discussion Our study indicates that changes in PVS-related MRI parameters occur in MCI and AD, possibly due to impairment of the glymphatic system. We also report the associations between MRI parameters and Aβ deposition, neuronal change, and cognitive impairment in AD.

DOI： 10.1212/WNL.0000000000201300

Interstitial Fluidopathy of the Central Nervous System: An Umbrella Term for Disorders with Impaired Neurofluid Dynamics 招待有り査読有り Open Access

Taoka, T; Ito, R; Nakamichi, R; Nakane, T; Kawai, H; Naganawa, S

MAGNETIC RESONANCE IN MEDICAL SCIENCES 23 巻 ( 1 ) 頁： 1 - 13 2022年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Magnetic Resonance in Medical Sciences

Interest in interstitial fluid dynamics has increased since the proposal of the glymphatic system hypothesis. Abnormal dynamics of the interstitial fluid have been pointed out to be an important factor in various pathological statuses. In this article, we propose the concept of central nervous system interstitial fluido-pathy as a disease or condition in which abnormal interstitial fluid dynamics is one of the important factors for the development of a pathological condition. We discuss the aspects of interstitial fluidopathy in various diseases, including Alzheimer’s disease, Parkinson’s disease, normal pressure hydrocephalus, and cerebral small vessel disease. We also discuss a method called “diffusion tensor image analysis along the perivascular space” using MR diffusion images, which is used to evaluate the degree of interstitial fluidopathy or the activity of the glymphatic system.

DOI： 10.2463/mrms.rev.2022-0012

Impact of tissue properties on time-dependent alterations in apparent diffusion coefficient: a phantom study using oscillating-gradient spin-echo and pulsed-gradient spin-echo sequences 査読有り Open Access

Ichikawa, K; Taoka, T; Ozaki, M; Sakai, M; Yamaguchi, H; Naganawa, S

JAPANESE JOURNAL OF RADIOLOGY 40 巻 ( 9 ) 頁： 970 - 978 2022年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Japanese Journal of Radiology

Purpose: The purpose of this study was to investigate whether the changes in apparent diffusion coefficients (ADCs) due to differences in diffusion time reflect tissue properties in actual measurements of phantoms. Materials and methods: Various n-alkane phantoms and sucrose/collagen phantoms with various collagen densities were set up with and without polyvinyl alcohol (PVA) foam with an average pore diameter of 300 μm. Thus, n-alkanes or sucrose/collagen represented substrate viscosity and the presence of PVA foam represented tissue structure with septum. Diffusion-weighted images with various diffusion times (7.71–60 ms) were acquired using pulsed-gradient spin-echo (PGSE) and oscillating-gradient spin-echo (OGSE) sequences. The ADCs of the phantoms with and without PVA foam were calculated. Results: The ADCs of some of the phantoms without PVA decreased with diffusion times decreased. In the n-alkane phantoms, only C8H18 showed significantly different ADCs depending on the use of PVA foam in the OGSE sequence. On the other hand, sucrose/collagen phantoms showed significant differences according to diffusion time. The ADCs of the phantoms decreased as the molecular size of the n-alkanes or collagen density of the sucrose/collagen phantom increased. Compared to phantoms without PVA foam, the ADC of the phantoms with PVA foam decreased as the diffusion time increased. Conclusion: Changes in ADCs due to differences in diffusion time reflect tissue properties in actual measurements of phantoms. These changes in ADCs can be used for tissue characterization in vivo.

DOI： 10.1007/s11604-022-01281-2

Spontaneous regression of asymptomatic tumefactive perivascular spaces in the anterior temporal lobe Open Access

Hashida, M; Nagashima, Y; Nishimura, Y; Eguchi, K; Taoka, T; Kawai, H; Saito, R

NAGOYA JOURNAL OF MEDICAL SCIENCE 84 巻 ( 3 ) 頁： 678 - 685 2022年8月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Nagoya Journal of Medical Science

Perivascular spaces are fluid-filled spaces that surround the perforating vessels of the brain and are normal findings on brain imaging. These are usually asymptomatic and are considered a manifestation of aging. Perivascular spaces occasionally undergo significant enlargement and are referred to as tumefactive perivascular spaces, which are often indistinguishable from neoplastic lesions. Spontaneous regression of tumefactive perivascular spaces during follow-up is rare. We report the imaging findings and clinical course of a patient who showed spontaneous regression of tumefactive perivascular spaces in the anterior temporal lobe, together with a literature review and discussion regarding the characteristics and pathogenesis of spontaneous regression of tumefactive perivascular spaces. Most studies in the available literature report tumefactive perivascular spaces in the anterior temporal lobe; in our view, the characteristics of anterior temporal lobe tumefactive perivascular spaces may differ from those of tumefactive perivascular spaces that occur at other locations.

DOI： 10.18999/nagjms.84.3.678

Contrast-Enhanced Fluid-Attenuated Inversion Recovery in Neuroimaging: A Narrative Review on Clinical Applications and Technical Advances 査読有り国際共著国際誌 Open Access

Ahn, SJ; Taoka, T; Moon, WJ; Naganawa, S

JOURNAL OF MAGNETIC RESONANCE IMAGING 56 巻 ( 2 ) 頁： 341 - 353 2022年8月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Magnetic Resonance Imaging

While contrast-enhanced fluid-attenuated inversion recovery (FLAIR) has long been regarded as an adjunct sequence to evaluate leptomeningeal disease in addition to contrast-enhanced T1-weighted imaging, it is gradually being used for more diverse pathologies beyond leptomeningeal disease. Contrast-enhanced FLAIR is known to be highly sensitive to low concentrations of gadolinium within the fluid. Accordingly, recent research has suggested the potential utility of contrast-enhanced FLAIR in various kinds of disease, such as Meniere's disease, seizure, stroke, traumatic brain injury, and brain metastasis, in addition to being used for visualizing glymphatic dysfunction. However, its potential applications have been reported sporadically in an unorganized manner. Furthermore, the exact mechanism for its superior sensitivity to low concentrations of gadolinium has not been fully understood. Rapidly developing magnetic resonance technology and unoptimized parameters for FLAIR may challenge its accurate application in clinical practice. This review provides the fundamental mechanism of contrast-enhanced FLAIR, systematically describes its current and potential clinical application, and elaborates on technical considerations for its optimization. Level of Evidence: 3. Technical Efficacy Stage: 5.

DOI： 10.1002/jmri.28117

Letter to editor on the article "A non-invasive, automated diagnosis of Meniere's disease using radiomics and machine learning on conventional magnetic resonance imaging: a multicentric, case-controlled feasibility study" by van der Lubbe Mfja et al. 国際誌

Naganawa, S; Ito, R; Taoka, T; Yoshida, T; Sone, M

RADIOLOGIA MEDICA 127 巻 ( 4 ) 頁： 458 - 459 2022年4月

Hybrid 3D T1-weighted gradient-echo sequence for fiducial marker detection and tumor delineation via magnetic resonance imaging in liver stereotactic body radiation therapy 国際誌 Open Access

Kato, Y; Kamomae, T; Kumagai, M; Oie, Y; Noguchi, Y; Okudaira, K; Kawamura, M; Taoka, T; Naganawa, S

PHYSICA MEDICA-EUROPEAN JOURNAL OF MEDICAL PHYSICS 95 巻頁： 9 - 15 2022年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Physica Medica

Purpose: Gold fiducial markers are used to guide liver stereotactic body radiation therapy (SBRT) and are hard to detect by magnetic resonance imaging (MRI). In this study, the parameters of the three-dimensional T1-weighted turbo gradient-echo (3D T1W-GRE) sequence were optimized for gold marker detection without degrading tumor delineation. Methods: Custom-made phantoms mimicking tumor and normal liver parenchyma were prepared and embedded with a gold marker. The 3D T1W-GRE was scanned by varying echo time (TE), bandwidth (BW), flip angle (FA), and base matrix size. The signal-to-noise ratio (SNR), contrast ratio (CR), and relative standard deviation (RSD) of the signal intensity in the area including the gold marker were evaluated, and the parameters were optimized accordingly. The modified 3D T1W-GRE (called HYBRID) was compared with the conventional T1W-GRE- and T2*-sequences in both phantom and clinical studies. In the clinical study of six patients with primary liver tumors, two observers visually assessed marker detection, tumor delineation, and overall image quality on a four-point scale. Results: In the phantom study, HYBRID showed significantly higher SNR and RSD than those of conventional T1W-GRE (P < 0.001). In the clinical study, HYBRID yielded significantly higher scores than conventional T1W-GRE did in terms of marker detection (P < 0.001). The scores of both sequences were not statistically different in terms of tumor delineation and overall image quality (P = 0.56 and P = 0.32). Conclusions: The proposed HYBRID sequence improved gold fiducial marker detection without degrading tumor delineation in MRI for SBRT of primary liver tumor.

DOI： 10.1016/j.ejmp.2022.01.003

Water Diffusivity Changes Along the Perivascular Space After Lumboperitoneal Shunt Surgery in Idiopathic Normal Pressure Hydrocephalus 国際誌 Open Access

Kikuta, J; Kamagata, K; Taoka, T; Takabayashi, K; Uchida, W; Saito, Y; Andica, C; Wada, A; Kawamura, K; Akiba, C; Nakajima, M; Miyajima, M; Naganawa, S; Aoki, S

FRONTIERS IN NEUROLOGY 13 巻頁： 843883 - 843883 2022年2月

Evaluation of system-related magnetic resonance imaging geometric distortion in radiation therapy treatment planning: two approaches and effectiveness of three-dimensional distortion correction Open Access

Kato, Y; Okudaira, K; Kamomae, T; Kumagai, M; Nagai, Y; Taoka, T; Itoh, Y; Naganawa, S

NAGOYA JOURNAL OF MEDICAL SCIENCE 84 巻 ( 1 ) 頁： 29 - 41 2022年2月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Nagoya Journal of Medical Science

We propose two methods to evaluate system-related distortion in magnetic resonance imaging (MRI)in radiation therapy treatment planning (RTP) and demonstrate the importance of three-dimensional (3D)distortion correction (DC) by quantitatively measuring the distortion magnitude. First, a small pin phantomwas scanned at multiple positions using an external laser guide for accurate phantom placement andcombined into one image encompassing a large area. Direct plane images were used for evaluating in-planedistortion and multiplanar reconstruction images for through-plane distortion with no DC, two-dimensional(2D) DC, and 3D DC. Second, a large grid sheet was scanned as the direct plane of the phantom placement.The distortion magnitude was determined by measuring the displacement between the MRI and referencecoordinates. The measured distortions were compared between in and through-plane when applying DCand between the two methods. The small pin phantom method can be used to evaluate a wide range ofdistortions, whereas data from the entire plane can be obtained with a single scan using the grid sheetwithout a laser guide. The mean distortion magnitudes differed between the methods. Furthermore, the 3DDC reduced in and through-plane distortions. In conclusion, the small pin phantom method can be usedto evaluate a wide range of distortions by creating a combined image, whereas the grid sheet methodis simpler, accurate, repeatable, and does not require a special-order phantom or laser guide. As 3D DCreduces both in and through-plane distortions, it can be used to improve RTP quality

DOI： 10.18999/nagjms.84.1.29

特集 "-pathy"でせまる中枢神経疾患序説にかえて-umbrella term の意義とpenumbra

田岡俊昭

画像診断 42 巻 ( 2 ) 頁： 134 - 135 2022年1月

特集 "-pathy"でせまる中枢神経疾患 CNS interstitial fluidopathy ─ 膜と水動態の異常

田岡俊昭

画像診断 42 巻 ( 2 ) 頁： 197 - 207 2022年1月

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

Kamiya, S; Satake, H; Hayashi, Y; Ishigaki, S; Ito, R; Kawamura, M; Taoka, T; Iwano, S; Naganawa, S

BREAST CANCER 29 巻 ( 1 ) 頁： 164 - 173 2022年1月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Breast Cancer

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

An Investigation of Water Diffusivity Changes along the Perivascular Space in Elderly Subjects with Hypertension Open Access

Kikuta, J; Kamagata, K; Takabayashi, K; Taoka, T; Yokota, H; Andica, C; Wada, A; Someya, Y; Tamura, Y; Kawamori, R; Watada, H; Naganawa, S; Aoki, S

AMERICAN JOURNAL OF NEURORADIOLOGY 43 巻 ( 1 ) 頁： 48 - 55 2022年1月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：American Journal of Neuroradiology

BACKGROUND AND PURPOSE: Hypertension may be related to alterations of the glymphatic system, a waste metabolite drainage system in the brain. We aimed to investigate analysis along the perivascular space index changes in elderly subjects with hypertension. MATERIALS AND METHODS: Diffusion-weighted images were acquired from 126 subjects, including 63 subjects with hypertension (25 men and 38 women; mean age, 72.45 years) and 63 age- and sex-matched controls (25 men and 38 women; mean age, 72.16 years). We calculated the analysis along the perivascular space index as a ratio of the mean of x-axis diffusivities in the projection and association areas to the mean of y-axis diffusivity in the projection area and z-axis diffusivity in the association area. The left, right, and mean analysis along the perivascular space indices of both hemispheres were compared between the hypertension and control groups using a Mann-Whitney U test. The Spearman correlation coefficient was used to assess the correlation between the left, right, and mean ALPS indices and blood pressure and pulse pressure. RESULTS: The left (P =.011) and mean (P =.024) analysis along the perivascular space indices of the hypertension group were significantly lower than that of the control group. The left, right, and mean analysis along the perivascular space indices of all subjects were significantly negatively correlated with blood pressure values (r = -0.200 to -0.278, P =.002-0.046) and pulse pressure values (r = -0.221 to -0.245, P =.006-0.013). CONCLUSIONS: Our results are consistent with a model in which hypertension causes glymphatic dysfunction.

DOI： 10.3174/ajnr.A7334

The Glymphatic System: A Review of the Challenges in Visualizing its Structure and Function with MR Imaging Open Access

Naganawa, S; Taoka, T

MAGNETIC RESONANCE IN MEDICAL SCIENCES 21 巻 ( 1 ) 頁： 182 - 194 2022年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Magnetic Resonance in Medical Sciences

Thecentralnervoussystem(CNS)waspreviouslythoughttobetheonlyorgansystemlackinglymphatic vessels to remove waste products from the interstitial space. Recently, based on the results from animal experiments, the glymphatic system was hypothesized. In this hypothesis, cerebrospinal fluid (CSF) enters the periarterial spaces, enters the interstitial space of the brain parenchyma via aquaporin-4 (AQP4) channels in the astrocyte end feet, and then exits through the perivenous space, thereby clearing waste products. From the perivenous space, the interstitial fluid drains into the subarachnoid space and meningeal lymphatics of the parasagittal dura. It has been reported that the glymphatic system is particularly active during sleep. Impairment of glymphatic system function might be a cause of various neurodegenerative diseases such as Alzheimer’s disease, normal pressure hydrocephalus, glaucoma, and others. Meningeal lymphatics regulate immunity in the CNS. Many researchers have attempted to visualize the function and structure of the glymphatic system and meningeal lymphatics in vivo using MR imaging. In this review, we aim to summarize these in vivo MR imaging studies and discuss the significance, current limitations, and future directions. We also discuss the significance of the perivenous cyst formation along the superior sagittal sinus, which is recently discovered in the downstream of the glymphatic system.

DOI： 10.2463/mrms.rev.2020-0122

Cross-sectional Area of the Superior Petrosal Sinus is Reduced in Patients with Significant Endolymphatic Hydrops Open Access

Naganawa, S; Ito, R; Kawai, H; Kawamura, M; Taoka, T; Yoshida, T; Sone, M

MAGNETIC RESONANCE IN MEDICAL SCIENCES 21 巻 ( 3 ) 頁： 459 - 467 2022年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Magnetic Resonance in Medical Sciences

Purpose: To evaluate the relationship between the size of the venous structures related to the inner ear and the degree of endolymphatic hydrops (EH). Methods: Thirty-four patients with a suspicion of EH underwent whole brain MR imaging including the inner ear. Images were obtained pre-and post-administration, and at 4 and 24 hours after the intravenous administration of a gadolinium-based contrast agent (IV-GBCA). The cross-sectional areas (CSA) of the internal jugular vein (IJV), superior petrosal sinus (SPS), and inferior petrosal sinus (IPS) were measured on the magnetization prepared rapid acquisition of gradient echo (MPRAGE) images obtained immediately after the IV-GBCA. The grade of EH was determined on the hybrid of reversed image of positive endolymph signal and native image of positive perilymph signal (HYDROPS) images obtained at 4 hours after IV-GBCA as no, mild, and significant EH according to the previously proposed grading system for the cochlea and vestibule, respectively. The ipsilateral CSA was compared between groups with each level of EH grade. P < 0.05 was considered statistically significant. Results: There were no statistically significant differences between EH grades for the CSA of the IJV or that of the IPS in either the cochlea or the vestibule. The CSA of the SPS in the groups with significant EH was significantly smaller than that in the group with no EH, for both the cochlea (P < 0.01) and the vestibule (P < 0.05). In an ROC analysis to predict significant EH, the cut-off CSA value in the SPS was 3.905 mm2 for the cochlea (AUC: 0.8762, 95% confidence interval [CI]: 0.7952‒0.9572) and 3.805 mm2 for the vestibule (AUC: 0.7727, 95% CI: 0.6539‒0.8916). Conclusion: In the ears with significant EH in the cochlea or vestibule, the CSA of the ipsilateral SPS was smaller than in the ears without EH.

DOI： 10.2463/mrms.mp.2021-0010

MR Imaging of Endolymphatic Hydrops in Five Minutes Open Access

Naganawa, S; Ito, R; Kawai, H; Kawamura, M; Taoka, T; Sakai, M; Ichikawa, K; Yoshida, T; Sone, M

MAGNETIC RESONANCE IN MEDICAL SCIENCES 21 巻 ( 3 ) 頁： 401 - 405 2022年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Magnetic Resonance in Medical Sciences

In this study, we present images acquired by a fast-imaging method for the evaluation of endolymphatic hydrops after intravenous administration of a single dose of gadolinium-based contrast agent. We utilized the hybrid of reversed image of MR cisternography and a positive perilymph signal by heavily T2-weighted 3D-fluid attenuated inversion recovery-multiplied by T2 (HYDROPS2-Mi2) method combined with deep learning reconstruction denoising. The scan time for the fast protocol was approximately 5 mins, which is far shorter than previously reported scan times. The fast acquisition provides similar image quality and less motion artifacts compared to the longer method.

DOI： 10.2463/mrms.ici.2021-0022

特集撮った,読んだ,わかった! 認知症画像診断認知症画像のカッティングエッジ2:Glymphaticシステム,CNS interstitial fluidopathyの概念

田岡俊昭

画像診断 41 巻 ( 14 ) 頁： 1543 - 1553 2021年11月

FLUID study: study protocol for an open-label, single-centre pilot study to investigate the efFect of Lemborexant on sleep management in Japanese sUbjects aged 50 years and older with Insomnia Disorder 国際誌 Open Access

Okada, I; Iwamoto, K; Miyata, S; Fujimoto, A; Tanaka, M; Amano, M; Matsuyama, N; Taoka, T; Naganawa, S; Ozaki, N

BMJ OPEN 11 巻 ( 11 ) 頁： e054885 2021年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：BMJ Open

Introduction Bidirectional associations have been reported between sleep disturbance and both cognitive impairment, including Alzheimer’s disease and amyloid beta-peptide (Aβ) accumulation. These relationships can be explained by the glymphatic system, which acts as a garbage drainage system in the brain. As interstitial fluid dynamics are suggested to increase during sleep, clearance of Aβ can be influenced by sleep disturbance or deprivation. We hypothesised that using lemborexant, an orexin receptor antagonist, to improve sleep quality would also improve the function of the glymphatic system. We plan to examine the effect of lemborexant on sleep quality and the glymphatic system among patients with insomnia disorder. Methods and analysis This pilot study is designed as an open-label, single-arm, single-centre trial. Thirty patients aged 50 years and over with insomnia will be recruited. The participants will take lemborexant (5 mg) at bedtime for 12 weeks and undergo a home-based sleep study at baseline and weeks 4 and 12, as well as MRI examinations to evaluate the glymphatic system at baseline and week 12. The primary outcome will be changes in objective sleep parameters as evaluated using a sleep monitoring system. The secondary outcomes will be changes in subjective sleep parameters. The relationships between changes in sleep parameters and the glymphatic system will be evaluated using diffusion tensor image analysis along the perivascular space, which is called the ALPS-index. Sleep parameters and the ALPS-index will be analysed using a paired t-test or Pearson’s correlation coefficient. Ethics and dissemination The study protocol was approved by Nagoya University Certified Review Board. The findings from this research will be published in peer-reviewed journals and be presented at local, national and international conferences.

DOI： 10.1136/bmjopen-2021-054885

Magnetic resonance cisternography imaging findings related to the leakage of Gadolinium into the subarachnoid space Open Access

Nakamichi, R; Taoka, T; Kawai, H; Yoshida, T; Sone, M; Naganawa, S

JAPANESE JOURNAL OF RADIOLOGY 39 巻 ( 10 ) 頁： 927 - 937 2021年10月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Japanese Journal of Radiology

Purpose: To identify magnetic resonance cisternography (MRC) imaging findings related to Gadolinium-based contrast agent (GBCA) leakage into the subarachnoid space. Materials and methods: The number of voxels of GBCA leakage (V-leak) on 3D-real inversion recovery images was measured in 56 patients scanned 4 h post-intravenous GBCA injection. Bridging veins (BVs) were identified on MRC. The numbers of BVs with surrounding cystic structures (BV-cyst), with arachnoid granulations protruding into the superior sagittal sinus (BV-AG-SSS) and the skull (BV-AG-skull), and including any of these factors (BV-incl) were recorded. Correlations between these variables and V-leak were examined based on the Spearman’s rank correlation coefficient. Receiver-operating characteristic (ROC) curves were generated to investigate the predictive performance of GBCA leakage. Results: V-leak and the number of BV-incl were strongly correlated (r = 0.609, p < 0.0001). The numbers of BV-cyst and BV-AG-skull had weaker correlations with V-leak (r = 0.364, p = 0.006; r = 0.311, p = 0.020, respectively). The number of BV-AG-SSS was not correlated with V-leak. The ROC curve for contrast leakage exceeding 1000 voxels and the number of BV-incl had moderate accuracy, with an area under the curve of 0.871. Conclusion: The number of BV-incl may be a predictor of GBCA leakage and a biomarker for waste drainage function without using GBCA.

DOI： 10.1007/s11604-021-01137-1

その他リンク： https://link.springer.com/article/10.1007/s11604-021-01137-1/fulltext.html

Changes in Vessel Wall Enhancement Related to the Recent Neurological Symptoms in Patients with Moyamoya Disease 査読有り Open Access

Muraoka, S; Taoka, T; Kawai, H; Okamoto, S; Uda, K; Naganawa, S; Araki, Y

NEUROLOGIA MEDICO-CHIRURGICA 61 巻 ( 9 ) 頁： 515 - 520 2021年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Neurologia Medico-Chirurgica

Moyamoya disease (MMD) causes intracranial arterial stenosis progression. The progression of intracranial arterial stenosis will increase the risk of ischemic cerebrovascular events. This study aims to investigate the relationship between intracranial arterial stenosis progression, vessel wall enhancement (VWE), and the recent neurological symptoms. A total of 39 MMD patients (12 male 37.6 ± 18.0 years old) were registered in this study analysis between April 2016 and July 2018. All patients received MRI at registration and 6, 12, and 24 months post-registration. The incidence of ischemic cerebrovascular events (transit ischemic attacks or cerebral infarction) was checked until December 2018. We evaluated the relationship between the intensity of VWE, intracranial arterial stenosis, and the recent neurological symptoms. During the mean follow-up period of 13.8 ± 5.5 months, the changes in VWE were observed in 33 hemispheres (42.3%), stenosis progression was observed in 21 hemispheres (26.9%), and recent neurological symptoms occurred in 10 hemispheres (12.8%). Stenosis progression was observed in 11 hemispheres (33.3%) in the VWE(+) group and ten hemispheres (22.2%) in the VWE(-) group (p = 0.310). The recent neurological symptoms were observed in eight hemispheres (21.2%) in the VWE(+) group and two hemispheres (4.44%) in the VWE(-) group (odds ratio 6.88, 95% confidence interval 1.35-34.98, p = 0.015). The intensity of VWE sometimes changes. The changes in VWE were significantly associated with the recent neurological symptoms but not with stenosis progression.

DOI： 10.2176/nmc.oa.2021-0058

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