研究者詳細 - 田岡　俊昭

特集 MRI最前線ガドリニウム造影剤と脳脊髄液　glymphaticシステムとは何か?

田岡俊昭, 長縄慎二

臨床画像 33 巻 ( 6 ) 頁： 652 - 663 2017年6月

Efficacy and safety of non-suture dural closure using a novel dural substitute consisting of polyglycolic acid felt and fibrin glue to prevent cerebrospinal fluid leakage-A non-controlled, open-label, multicenterclinical trial- 査読有り国際誌

Terasaka, S; Taoka, T; Kuroda, S; Mikuni, N; Nishi, T; Nakase, H; Fujii, Y; Hayashi, Y; Murata, J; Kikuta, K; Kuroiwa, T; Shimokawa, S; Houkin, K

JOURNAL OF MATERIALS SCIENCE-MATERIALS IN MEDICINE 28 巻 ( 5 ) 頁： 69 - 69 2017年5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 Materials Science: Materials in Medicine

Abstract: The objective of this study is to evaluate the efficacy and safety of non-suture dural closure using a novel dural substitute (GM111) consisting of polyglycolic acid felt with a fibrin-glue-coated area commensurate in size with the dural defect. This was a non-controlled, open-label, multicenter clinical trial. The efficacy evaluation endpoints were (1) GM111’s intra-operative capability to close dural defects and (2) prevention of cerebrospinal fluid (CSF) leakage and subcutaneous CSF retention throughout the postoperative period (evaluated by diagnostic imaging). Patients meeting the following three preoperative and two intra-operative selection criteria were enrolled: (1) between 12 and <75 years of age; (2) the dura is surmised to be defective and in need of reconstruction; (3) informed written consent was obtained from the patient; (4) the surgical wound is class 1; and (5) the size of duraplasty is ≥0.2 cm2 to <100 cm2. Sixty patients were enrolled. The craniotomy site was supratentorial in 77.2%, infratentorial in 12.3% and sellar in 10.5%. The GM111 prosthesis size ranged from 0.24 to 42 cm2. To evaluate the efficacy, intra-operative closure was confirmed by Valsalva’s maneuver, water infusion, etc., in all patients. CSF leakage and subcutaneous CSF retention throughout the postoperative period were found in four patients. Adverse events for which a causal relationship with GM111 could not be ruled out occurred in 8.8% of the patients. There were no instances of postoperative infection due to GM111. GM111 showed good closure capability and safety when used for non-suture dural closure. Graphical Abstract: [InlineMediaObject not available: see fulltext.]

DOI： 10.1007/s10856-017-5877-8

Carotid Artery Stenting Investigation of Plaque Protrusion Incidence and Prognosis 査読有り国際誌 Open Access

Kotsugi, M; Takayama, K; Myouchin, K; Wada, T; Nakagawa, I; Nakagawa, H; Taoka, T; Kurokawa, S; Nakase, H; Kichikawa, K

JACC-CARDIOVASCULAR INTERVENTIONS 10 巻 ( 8 ) 頁： 824 - 831 2017年4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：JACC: Cardiovascular Interventions

Objectives This study sought to clarify the incidence and prognosis of PP in carotid artery stenting (CAS). Background Projections thought to be plaque may be observed inside the stent on angiography or intravascular ultrasound (IVUS) during CAS. Known as plaque protrusion (PP), the incidence and prognosis of this complication are unclear. Methods A total of 354 consecutive carotid atherosclerotic stenoses in 328 patients (285 men, 43 women; age range 51 to 97 years [mean age 73.6 years]; 158 symptomatic cases; stenosis rate, 50% to 99% [mean 81.0%]) who underwent CAS under IVUS between October 2007 and March 2016 were retrospectively analyzed. PP was defined as plaque seen inside the stent lumen on both digital subtraction angiography and IVUS. The incidence and prognosis (rate of stroke within 30 post-operative days) of PP and the rate of ischemic lesions on the treated side on diffusion-weighted imaging performed within 48 post-operative hours within the PP group were investigated. Results PP was observed in 9 cases (2.6%). Ischemic stroke occurred in 6 of 9 PP cases (66.7%; 1 major, 5 minor). Ischemic lesions were observed on diffusion-weighted imaging in 8 of 9 cases (88.9%). PP was strongly associated with perioperative ischemic stroke. A significant increase in PP susceptibility was observed with open-cell stent use and unstable plaque. Conclusions The incidence of PP in CAS was 2.6%, with a high risk of ischemic complications if PP was observed. The present findings indicate the necessity of appropriate device selection to avoid PP.

DOI： 10.1016/j.jcin.2017.01.029

すとらびすむす青い瞬間,魔法の時間

田岡俊昭

画像診断 37 巻 ( 3 ) 頁： 247 - 247 2017年2月

Structure of the Medullary Veins of the Cerebral Hemisphere and Related Disorders 査読有り国際誌

Taoka, T; Fukusumi, A; Miyasaka, T; Kawai, H; Nakane, T; Kichikawa, K; Naganawa, S

RADIOGRAPHICS 37 巻 ( 1 ) 頁： 280 - 296 2017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：Radiographics

Deep medullary veins drain into subependymal veins with four convergence zones and show parallel distribution patterns adjacent to the body or inferior horn and a radial pattern in the frontal horn or trigon of the lateral ventricle. As white matter imaging develops such as diffusion tensor imaging or susceptibility-weighted imaging, requirements for understanding of white matter structures are increasing, not only for understanding of neuronal tracts but also for that of other structures including the fine anatomy of white matter vessels. Some disorders are related to deep medullary veins and show characteristic distributions of the lesions indicating the relationship to the medullary veins. When lesions show a parallel or radial distribution pattern in the certebral deep white matter, disorders related to deep medullary veins should be considered for differential diagnosis. In this review, we discuss disorders related to deep medullary veins, including (a) anomalies of the medullary veins, (b) hemorrhagic disorders related to the medullary veins (diffuse vascular injury due to high-energy trauma, deep medullary vein engorgement/thrombosis in neonates), (c) inflammatory changes that spread along the medullary veins, (d) neoplasms within the medullary veins, and (e) metabolic changes that lead to altered visualization of medullary veins. Understanding the anatomic structure of medullary veins in the cerebral hemisphere and becoming familiar with disorders in which the medullary veins play a major role in disease development may be helpful in the interpretation of brain images.

DOI： 10.1148/rg.2017160061

Revisiting Current Golden Rules in Managing Acute Ischemic Stroke: Evaluation of New Strategies to Further Improve Treatment Selection and Outcome 査読有り

Yuh, WTC; Alexander, MD; Ueda, T; Maeda, M; Taoka, T; Yamada, K; Beauchamp, NJ

AMERICAN JOURNAL OF ROENTGENOLOGY 208 巻 ( 1 ) 頁： 32 - 41 2017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 Roentgenology

OBJECTIVE. Advanced stroke imaging has generated much excitement for the early diagnosis of acute ischemic stroke (AIS) and facilitation of intervention. However, its therapeutic impact has not matched its diagnostic utility; most notably, lacking significant contributions to recent major AIS clinical trials. It is time to reexamine the fundamental hypotheses from the enormous body of imaging research on which clinical practices are based and reassess the current standard clinical and imaging strategies, or golden rules, established over decades for AIS. In this article, we will investigate a possible new window of opportunity in managing AIS through a better understanding of the following: first, the potential limitations of the golden rules; second, the significance of imaging-based parenchymal hypoperfusion (i.e., lower-Thannormal relative cerebral blood flow [rCBF] may not be indicative of ischemia); third, the other critical factors (e.g., rCBF, collateral circulation, variable therapeutic window, chronicity of occlusion) that reflect more individual ischemic injury for optimal treatment selection; and, fourth, the need for penumbra validation in successfully reperfused patients (not in untreated patients). CONCLUSION. Individual variations in the therapeutic window, ischemic injury (rCBF), and chronicity of vascular lesion development have not been comprehensively incorporated in the standard algorithms used to manage AIS. The current established imaging parameters have not been consistently validated with successfully reperfused patients and rCBF to quantitatively distinguish between oligemia and ischemia and between penumbra and infarct core within ischemic tissue. A novel paradigm incorporating rCBF values or indirectly incorporating relative rCBF values with higher statistically powered imaging studies to more reliably assess the severity of ischemic injury and differentiate reversibility from viability within the area of imagingbased parenchymal hypoperfusion may provide a more personalized approach to treatment, including no treatment of infarction core, to further enhance outcomes.

DOI： 10.2214/AJR.16.16557

Lack of Contrast Enhancement in a Giant Perivascular Space of the Basal Ganglion on Delayed FLAIR Images: Implications for the Glymphatic System 査読有り Open Access

Naganawa, S; Nakane, T; Kawai, H; Taoka, T

MAGNETIC RESONANCE IN MEDICAL SCIENCES 16 巻 ( 2 ) 頁： 89 - 90 2017年

Visualization of Middle Ear Ossicles in Elder Subjects with Ultra-short Echo Time MR Imaging 査読有り Open Access

Naganawa, S; Nakane, T; Kawai, H; Taoka, T; Suzuki, K; Iwano, S; Satake, H; Grodzki, D

MAGNETIC RESONANCE IN MEDICAL SCIENCES 16 巻 ( 2 ) 頁： 93 - 97 2017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 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 × 0.83 × 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

Gd-based Contrast Enhancement of the Perivascular Spaces in the Basal Ganglia 査読有り Open Access

Naganawa, S; Nakane, T; Kawai, H; Taoka, T

MAGNETIC RESONANCE IN MEDICAL SCIENCES 16 巻 ( 1 ) 頁： 61 - 65 2017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: In textbooks, the perivascular space (PVS) is described as non-enhancing after the intravenous administration of gadolinium-based contrast agent (IV-GBCA). We noticed that the PVS sometimes has high signal intensity (SI) on heavily T2-weighted 3D-FLAIR (hT2-FL) images obtained 4 h after IV-GBCA. The purpose of this study was to retrospectively evaluate the contrast enhancement of the PVS. Materials and Methods: In 8 healthy subjects and 19 patients with suspected endolymphatic hydrops, magnetic resonance cisternography (MRC) and hT2-FL images were obtained before and 4 h after a single dose of IV-GBCA. No subjects had renal insufficiency. On axial MRC at the level of the anterior commissure (AC)-posterior commissure (PC) line, 1 cm circular regions of interest (ROIs) were drawn centering on the PVS in the bilateral basal ganglia and thalami. Three-millimeter diameter ROIs were set in the cerebrospinal fluid (CSF) of the bilateral ambient cistern. The ROIs on MRC were copied onto the hT2-FL images and the SI was measured. The SI ratio (SIR) was defined as SIRPVS = SI of PVS/SI of the thalami, and SIRCSF = SI of CSF/SI of the thalami. The average of the bilateral values was used for the calculation. The SIRCSF, SIRPVS, and SI of the thalami were compared between before and 4 h after IV-GBCA. Results: The SIR was increased significantly from 1.02 ± 0.37 to 2.65 ± 0.82 in the CSF (P < 0.01) and from 1.20 ± 0.35 to 2.13 ± 1.23 in the PVS at 4 h after IV-GBCA (P < 0.01). The SI of the thalami showed no significant difference. Conclusion: The enhancement of the PVS at 4 h after IV-GBCA was confirmed even in subjects without renal insufficiency. It is possible that the GBCA in the blood vessels might have permeated into the cerebrospinal fluid (CSF) space and the PVS. This might be a first step in the imaging evaluation of the glymphatic system (waste clearance system) of the brain.

DOI： 10.2463/mrms.mp.2016-0039

Improved HYDROPS: Imaging of Endolymphatic Hydrops after Intravenous Administration of Gadolinium 査読有り Open Access

Naganawa, S; Kawai, H; Taoka, T; Sone, M

MAGNETIC RESONANCE IN MEDICAL SCIENCES 16 巻 ( 4 ) 頁： 357 - 361 2017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

To improve the imaging protocol for the evaluation of endolymphatic hydrops after intravenous administration of a gadolinium-based contrast agent, we modified our previously reported hybrid of reversed image of positive endolymph signal and native image of positive perilymph signal (HYDROPS) method. Although the scan time of the new protocol was half that of the previous one, there were no significant differences between two protocols in the mean contrast noise ratio between the endolymph and perilymph and the area ratio of the endolymph size values in nine patients.

DOI： 10.2463/mrms.tn.2016-0126

Structures Showing Negative Correlations of Signal Intensity with Postnatal Age on T<sub>1</sub>-weighted Imaging of the Brain of Newborns and Infants 査読有り Open Access

Hori, S; Taoka, T; Ochi, T; Miyasaka, T; Sakamoto, M; Takayama, K; Wada, T; Myochin, K; Takahashi, Y; Kichikawa, K

MAGNETIC RESONANCE IN MEDICAL SCIENCES 16 巻 ( 4 ) 頁： 333 - 339 2017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: Although the neonatal and infantile brain typically shows sequential T1 shortening according to gestational age as a result of myelination, several structures do not follow this rule. We evaluated the relationship between the signal intensity of various structures in the neonatal and infantile brain on T1-weighted imaging (T1WI) and either postnatal or gestational age. Materials and Methods: We examined magnetic resonance images from 120 newborns and infants without any abnormalities in the central nervous system. Written informed consent was obtained from all parents and the institutional review board approved the study. Gestational age at examination ranged from 35 weeks, 3 days to 46 weeks, 6 days, and postnatal age ranged from 7 days to 127 days. Signal intensity on T1WI was evaluated on a scale from Grade 1 (indistinguishable from surrounding structures) to Grade 4 (higher than cortex and close to fat). We evaluated relationships between the T1 signal grades of various structures in the neonatal brain and postnatal or gestational age using Spearman’s correlation analysis. Results: Significant positive correlations were identified between T1 signal grade and gestational age in the pyramidal tract (P < 0.001). Conversely, significant negative correlations were evident between T1 signal grade and postnatal age (P < 0.001), in structures including the stria medullaris thalami, fornix cerebellar vermis, dentate nucleus and anterior pituitary gland. Conclusion: Significant negative correlations exist between signal intensity on T1WI and postnatal age in some structures of the neonatal and infantile brain. Some mechanisms other than myelination might play roles in the course of signal appearance.

DOI： 10.2463/mrms.mp.2015-0168

Diffusion Tensor Imaging in Dementia 査読有り

Taoka Toshiaki

Neuroimaging Diagnosis for Alzheimer's Disease and Other Dementias 頁： 117 - 128 2017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：Springer, Tokyo

While there are huge number of reports in the gray matter changes in Alzheimer's disease (AD), there are also increasing number of reports on white matter changes in the cases of AD due to the development of diffusion tensor methods. This report summarizes the recent knowledge about white matter lesions in Alzheimer's disease.

DOI： 10.1007/978-4-431-55133-1_5