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Tomizawa N, Fujimoto S, Takahashi D, Nozaki Y, Fan R, Kudo A, Kawaguchi Y, Takamura K, Hiki M, Kadowaki S, Ikeda F, Kumamaru KK, Watada H, Minamino T, Aoki S. Energy loss is related to CT fractional flow reserve progression in type 2 diabetes mellitus patients. Am Heart J Plus 2023; 35:100328. [PMID: 38511178 PMCID: PMC10945932 DOI: 10.1016/j.ahjo.2023.100328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 03/22/2024]
Abstract
Background We aimed to investigate the diagnostic value of energy loss (EL) and baseline CT fractional flow reserve (CT-FFR) computed using computational fluid dynamics to predict functional progression of coronary stenosis in patients with type 2 diabetes mellitus. Methods This single-center prospective study included 61 patients with type 2 diabetes mellitus (mean age, 61 years ±9 [SD]; 43 men) showing 20-70 % stenosis who underwent serial coronary CT performed at 2-year interval between October 2015 and March 2020. A mesh-free simulation was performed to calculate the CT-FFR and EL. Functional progression was defined as ≥ 0.05 decrease in CT-FFR on the second coronary CT. Models using baseline CT-FFR and EL were compared by analyzing the receiver operating characteristic (ROC) curve. Results Of the 94 vessels evaluated, 25 vessels (27 %) showed functional progression. EL at distal stenosis (ELdis) of vessels with functional progression was higher than that of vessels without functional progression (27.6 W/m3 [interquartile range (IQR): 15.0, 53.0] vs. 5.7 W/m3 [IQR: 2.3, 10.1], p < 0.001). Multivariable analysis showed that ELdis (per unit Ln(EL); odds ratio, 11.8; 95 % CI: 4.0-34.9; p < 0.001) remained as a predictor of functional progression after adjustment for diameter stenosis and baseline CT-FFR. The area under the ROC curve using ELdis (0.89; 95 % CI: 0.82-0.96) was higher than that using baseline CT-FFR (0.71; 95 % CI: 0.59-0.83; p < 0.001). Conclusion When ELdis and baseline CT-FFR were considered, ELdis was a better predictor of functional progression of coronary stenosis.
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Affiliation(s)
- Nobuo Tomizawa
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daigo Takahashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yui Nozaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ruiheng Fan
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ayako Kudo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuko Kawaguchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoshi Kadowaki
- Department of Diabetes, Endocrinology, and Metabolism, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fuki Ikeda
- Department of Diabetes, Endocrinology, and Metabolism, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kanako K. Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirotaka Watada
- Department of Diabetes, Endocrinology, and Metabolism, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Tomizawa N, Fujimoto S, Mita T, Takahashi D, Nozaki Y, Fan R, Kudo A, Kawaguchi Y, Takamura K, Hiki M, Kurita M, Kumamaru KK, Watada H, Minamino T, Aoki S. Coronary Artery Vorticity to Predict Functional Plaque Progression in Participants with Type 2 Diabetes Mellitus. Radiol Cardiothorac Imaging 2023; 5:e230016. [PMID: 37693191 PMCID: PMC10483244 DOI: 10.1148/ryct.230016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/07/2023] [Accepted: 07/20/2023] [Indexed: 09/12/2023]
Abstract
Purpose To investigate whether vorticity could predict functional plaque progression better than high-risk plaque (HRP) and lesion length (LL) in individuals with type 2 diabetes mellitus. Materials and Methods This single-center prospective study included 61 participants (mean age, 61 years ± 9 [SD]; 43 male participants) who underwent serial coronary CT angiography at 2 years, with 20%-70% stenosis at initial CT between October 2015 and March 2020. The number of the following HRP characteristics was recorded: low attenuation, positive remodeling, spotty calcification, and napkin-ring sign. Vorticity was calculated using a mesh-free simulation. A decrease in CT fractional flow reserve larger than 0.05 indicated functional progression. Models using HRP and LL and vorticity were compared using receiver operating characteristic curve analysis. Results Of the 94 vessels evaluated, 25 vessels (27%) showed functional progression. Vessels with functional progression showed higher vorticity at distal stenosis (984 sec-1; IQR: 730-1253 vs 443 sec-1; IQR: 295-602; P < .001) than vessels without progression. The area under the receiver operating characteristic curve of vorticity (0.91; 95% CI: 0.84, 0.97) was higher than that of HRP and LL (0.69; 95% CI: 0.56, 0.82; P < .01). Diagnostic accuracy of vorticity (85%; 80 of 94 vessels; 95% CI: 76, 92) was higher than that of HRP and LL (72%; 68 of 94 vessels; 95% CI: 62, 81; P = .004). Conclusion In participants with type 2 diabetes mellitus, vorticity at distal stenosis was a better predictor of functional plaque progression than HRP and LL.Keywords: Coronary Artery, Vorticity, Functional Plaque Progression, Type 2 Diabetes, Vasculature, CT Angiography, Computational Fluid Dynamics, Fractional Flow Reserve Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Nobuo Tomizawa
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shinichiro Fujimoto
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Tomoya Mita
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Daigo Takahashi
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yui Nozaki
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ruiheng Fan
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ayako Kudo
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuko Kawaguchi
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kazuhisa Takamura
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Makoto Hiki
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Mika Kurita
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kanako K. Kumamaru
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hirotaka Watada
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Tohru Minamino
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shigeki Aoki
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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Takahashi D, Fujimoto S, Nozaki YO, Kudo A, Kawaguchi YO, Takamura K, Hiki M, Sato H, Tomizawa N, Kumamaru KK, Aoki S, Minamino T. Validation and clinical impact of novel pericoronary adipose tissue measurement on ECG-gated non-contrast chest CT. Atherosclerosis 2023; 370:18-24. [PMID: 36754662 DOI: 10.1016/j.atherosclerosis.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/16/2022] [Accepted: 01/24/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS We aimed to develop a method for quantifying pericoronary adipose tissue (PCAT) on electrocardiogram (ECG)-gated non-contrast CT (NC-PCAT) and validate its efficacy and prognostic value. METHODS We retrospectively studied two independent cohorts. PCAT was quantified conventionally. NC-PCAT was defined as the mean CT value of epicardial fat tissue adjacent to right coronary artery ostium on ECG-gated non-contrast CT. In cohort 1 (n = 300), we evaluated the correlation of two methods and the association between NC-PCAT and CT-verified high-risk plaque (HRP). We dichotomized cohort 2 (n = 333) by the median of NC-PCAT, and assessed the prognostic value of NC-PCAT for primary endpoint (all-cause death and non-fatal myocardial infarction) by Cox regression analysis. The median duration of follow-up was 2.9 years. RESULTS NC-PCAT was correlated with PCAT (r = 0.68, p<0.0001). In multivariable logistic regression analysis, high NC-PCAT (OR:1.06; 95%CI:1.03-1.10; p = 0.0001), coronary artery calcium score (CACS) (OR:1.01 per 10 CACS increase, 95%CI:1.00-1.02; p = 0.013), and current smoking (OR:2.58; 95%CI:1.03-6.49; p = 0.044) were independent predictors of HRP. Among patients with CACS>0 (n = 193), NC-PCAT (OR:1.06; 95%CI:1.03-1.10; p = 0.0002), current smoking (OR:3.02; 95%CI:1.17-7.82; p = 0.027), and male sex (OR:2.81; 95%CI:1.06-7.48; p = 0.028) were independent predictors of HRP, whereas CACS was not (p = 0.15). Multivariable Cox regression analysis revealed high NC-PCAT as an independent predictor of the primary endpoint, even after adjustment for sex and age (HR:4.3; 95%CI:1.2-15.2; p = 0.012). CONCLUSIONS There was a positive correlation between NC-PCAT and PCAT, with high NC-PCAT significantly associated with worse clinical outcome (independent of CACS) as well as presence of HRP.
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Affiliation(s)
- Daigo Takahashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Yui O Nozaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ayako Kudo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuko O Kawaguchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hideyuki Sato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Radiological Technology, Juntendo University Hospital, Tokyo, Japan
| | - Nobuo Tomizawa
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Tomizawa N, Nozaki Y, Fujimoto S, Fan R, Takahashi D, Kudo A, Kamo Y, Aoshima C, Kawaguchi Y, Takamura K, Hiki M, Dohi T, Okazaki S, Kumamaru KK, Minamino T, Aoki S. Feasibility of CT Angiography-derived Kinetic Energy of Coronary Flow to Improve the Detection of Hemodynamically Significant Coronary Stenosis. Radiol Cardiothorac Imaging 2022; 4:e220147. [PMID: 36601450 PMCID: PMC9806723 DOI: 10.1148/ryct.220147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/28/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022]
Abstract
Purpose To investigate whether coronary flow kinetic energy has incremental value over simulated fractional flow reserve (sFFR) in diagnosing hemodynamically significant stenosis assessed with coronary CT angiography and invasive fractional flow reserve (FFR). Materials and Methods This single-center retrospective study included 113 patients (mean age, 68 years ± 9 [SD]; 80 men) who underwent coronary CT angiography showing intermediate stenosis (30%-70% stenosis) and subsequent invasive FFR between December 2015 and March 2020. Kinetic energy was calculated using proximal coronary diameter and myocardial mass of the stenotic region. A mesh-free simulation was performed to calculate the sFFR. Invasive FFR of 0.80 or less indicated hemodynamically significant stenosis. Models using diameter stenosis, kinetic energy, and sFFR were compared by analyzing the receiver operating characteristic curve. Results Of the 144 vessels evaluated, 53 vessels (37%) had hemodynamically significant stenosis. Kinetic energy of vessels with significant stenosis was higher than that of vessels with nonsignificant stenosis (79 mJ/kg [IQR, 58-104 mJ/kg] vs 36 mJ/kg [IQR, 23-59 mJ/kg]; P < .001). Multivariable analysis including diameter stenosis and sFFR showed that kinetic energy (per 20 mJ/kg; odds ratio, 1.92; 95% CI: 1.37, 2.95; P < .001) was a predictor of hemodynamically significant stenosis. Adding kinetic energy to diameter stenosis and sFFR improved the area under the receiver operating characteristic curve from 0.89 (95% CI: 0.84, 0.95) to 0.93 (95% CI: 0.89, 0.97) (P = .04). Conclusion Kinetic energy had incremental value over sFFR in detecting hemodynamically significant stenosis assessed with invasive FFR.Keywords: Coronary CT Angiography, Coronary Arteries, Fractional Flow Reserve, Kinetic Energy, Cardiac Supplemental material is available for this article © RSNA, 2022.
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Tomizawa N, Nozaki Y, Fujimoto S, Takahashi D, Kudo A, Kamo Y, Aoshima C, Kawaguchi Y, Takamura K, Hiki M, Dohi T, Okazaki S, Kumamaru KK, Minamino T, Aoki S. Coronary flow disturbance assessed by vorticity as a cause of functionally significant stenosis. Eur Radiol 2022; 32:6859-6867. [PMID: 35778509 DOI: 10.1007/s00330-022-08974-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/05/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Vorticity calculated using computational fluid dynamics (CFD) could assess the flow disturbance generated by coronary stenosis. The purpose of this study was to investigate whether vorticity would be an underlying cause of functionally significant stenosis assessed by invasive fractional flow reserve (FFR). METHODS This retrospective study included 113 patients who underwent coronary CT angiography showing intermediate stenosis and subsequent invasive FFR between December 2015 and March 2020. Vorticity at the stenosis site was calculated using a mesh-free CFD method. We also evaluated the minimum lumen area (MLA) and diameter stenosis (DS) of the lesion. Invasive FFR of ≤ 0.80 was considered functionally significant. Data were compared using Student's t-test and logistic regression analysis was performed. RESULTS Of the evaluated 144 vessels, 53 vessels (37%) showed FFR ≤ 0.80. Vorticity of significant stenosis was significantly higher than non-significant stenosis (569 ± 78 vs. 328 ± 34 s-1, p < 0.001). A significant negative relationship was present between vorticity and invasive FFR (R2 = 0.31, p < 0.001). Multivariate logistic regression analysis including MLA and DS showed that vorticity (per 100 s-1, odds ratio: 1.36, 95% confidence interval: 1.21-1.57, p < 0.001) was a statistically significant factor to detect functional significance. The area under the receiver operating characteristic curve statistically significantly increased when vorticity was combined with DS and MLA (0.76 vs. 0.87, p = 0.001). CONCLUSIONS Vorticity had a statistically significant negative relationship with invasive FFR independent of geometric stenosis. KEY POINTS • Flow disturbance caused by coronary stenosis could be evaluated by calculating vorticity which is defined as the norm of the rotation of the velocity vector. • Vorticity was statistically significantly higher in stenosis with functional significance than stenosis without. • Vorticity has an additive value to detect functionally significant stenosis over geometrical stenosis.
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Affiliation(s)
- Nobuo Tomizawa
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Yui Nozaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daigo Takahashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ayako Kudo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Kamo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Chihiro Aoshima
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuko Kawaguchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Nozaki YO, Fujimoto S, Kawaguchi YO, Aoshima C, Kamo Y, Sato H, Kudo H, Takamura K, Kudo A, Takahashi D, Hiki M, Dohi T, Tomizawa N, Kumamaru KK, Aoki S, Minamino T. Prognostic value of the optimal measurement location of on-site CT-derived fractional flow reserve. J Cardiol 2022; 80:14-21. [DOI: 10.1016/j.jjcc.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/14/2022] [Accepted: 02/25/2022] [Indexed: 11/26/2022]
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Suzuki K, Otsuka Y, Nomura Y, Kumamaru KK, Kuwatsuru R, Aoki S. Development and Validation of a Modified Three-Dimensional U-Net Deep-Learning Model for Automated Detection of Lung Nodules on Chest CT Images From the Lung Image Database Consortium and Japanese Datasets. Acad Radiol 2022; 29 Suppl 2:S11-S17. [PMID: 32839096 DOI: 10.1016/j.acra.2020.07.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/13/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVES A more accurate lung nodule detection algorithm is needed. We developed a modified three-dimensional (3D) U-net deep-learning model for the automated detection of lung nodules on chest CT images. The purpose of this study was to evaluate the accuracy of the developed modified 3D U-net deep-learning model. MATERIALS AND METHODS In this Health Insurance Portability and Accountability Act-compliant, Institutional Review Board-approved retrospective study, the 3D U-net based deep-learning model was trained using the Lung Image Database Consortium and Image Database Resource Initiative dataset. For internal model validation, we used 89 chest CT scans that were not used for model training. For external model validation, we used 450 chest CT scans taken at an urban university hospital in Japan. Each case included at least one nodule of >5 mm identified by an experienced radiologist. We evaluated model accuracy using the competition performance metric (CPM) (average sensitivity at 1/8, 1/4, 1/2, 1, 2, 4, and 8 false-positives per scan). The 95% confidence interval (CI) was computed by bootstrapping 1000 times. RESULTS In the internal validation, the CPM was 94.7% (95% CI: 89.1%-98.6%). In the external validation, the CPM was 83.3% (95% CI: 79.4%-86.1%). CONCLUSION The modified 3D U-net deep-learning model showed high performance in both internal and external validation.
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Affiliation(s)
- Kazuhiro Suzuki
- Department of Radiology, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo 113-8431, Japan.
| | - Yujiro Otsuka
- Department of Radiology, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo 113-8431, Japan; Plusmann LLC, Tokyo, Japan; Milliman, Inc., Tokyo, Japan
| | - Yukihiro Nomura
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
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8
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Azuma M, Kumamaru KK, Hirai T, Khant ZA, Koba R, Ijichi S, Jinzaki M, Murayama S, Aoki S. A National Survey on Safety Management at MR Imaging Facilities in Japan. Magn Reson Med Sci 2021; 20:347-358. [PMID: 33239490 PMCID: PMC8922353 DOI: 10.2463/mrms.mp.2020-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate safety management at Japanese facilities performing human MRI studies. METHODS All Japanese facilities performing human MRI studies were invited to participate in a comprehensive survey that evaluated their MRI safety management. The survey used a questionnaire prepared with the cooperation of the Safety Committee of the Japanese Society for Magnetic Resonance in Medicine. The survey addressed items pertaining to the overall MRI safety management, questions on the occurrence of incidents, and questions specific to facility and MRI scanner or examination. The survey covered the period from October 2017 to September 2018. Automated machine learning was used to identify factors associated with major incidents. RESULTS Of 5914 facilities, 2015 (34%) responded to the questionnaire. There was a wide variation in the rate of compliance with MRI safety management items among the participating facilities. Among the facilities responding to this questionnaire, 5% reported major incidents and 27% reported minor incidents related to MRI studies. Most major incidents involved the administration of contrast agents. The most influential factor in major incidents was the total number of MRI studies performed at the facility; this number was significantly correlated with the risk of major incidents (P < 0.0001). CONCLUSION There were large variations in the safety standards applied at Japanese facilities performing clinical MRI studies. The total number of MRI studies performed at a facility affected the number of major incidents.
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Affiliation(s)
- Minako Azuma
- Department of Radiology, Faculty of Medicine, University of Miyazaki
| | - Kanako K Kumamaru
- Department of Radiology, Graduate School of Medicine, Juntendo University
| | - Toshinori Hirai
- Department of Radiology, Faculty of Medicine, University of Miyazaki
| | - Zaw Aung Khant
- Department of Radiology, Faculty of Medicine, University of Miyazaki
| | - Ritsuko Koba
- Department of Radiology, Graduate School of Medicine, Juntendo University.,Varian Medical Systems K.K
| | - Shinpei Ijichi
- Department of Radiology, Graduate School of Medicine, Juntendo University.,DataRobot Inc
| | | | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyu
| | - Shigeki Aoki
- Department of Radiology, Graduate School of Medicine, Juntendo University
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9
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Kamo Y, Fujimoto S, Nozaki YO, Aoshima C, Kawaguchi YO, Dohi T, Kudo A, Takahashi D, Takamura K, Hiki M, Okai I, Okazaki S, Tomizawa N, Kumamaru KK, Aoki S, Minamino T. Incremental Diagnostic Value of CT Fractional Flow Reserve Using Subtraction Method in Patients with Severe Calcification: A Pilot Study. J Clin Med 2021; 10:jcm10194398. [PMID: 34640414 PMCID: PMC8509262 DOI: 10.3390/jcm10194398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/30/2022] Open
Abstract
Although on-site workstation-based CT fractional flow reserve (CT-FFR) is an emerging method for assessing vessel-specific ischemia in coronary artery disease, severe calcification is a significant factor affecting CT-FFR’s diagnostic performance. The subtraction method significantly improves the diagnostic value with respect to anatomic stenosis for patients with severe calcification in coronary CT angiography (CCTA). We evaluated the diagnostic capability of CT-FFR using the subtraction method (subtraction CT-FFR) in patients with severe calcification. This study included 32 patients with 45 lesions with severe calcification (Agatston score >400) who underwent both CCTA and subtraction CCTA using 320-row area detector CT and also received invasive FFR within 90 days. The diagnostic capabilities of CT-FFR and subtraction CT-FFR were compared. The sensitivities, specificities, positive predictive values (PPVs), and negative predictive values (NPVs) of CT-FFR vs. subtraction CT-FFR for detecting hemodynamically significant stenosis, defined as FFR ≤ 0.8, were 84.6% vs. 92.3%, 59.4% vs. 75.0%, 45.8% vs. 60.0%, and 90.5% vs. 96.0%, respectively. The area under the curve for subtraction CT-FFR was significantly higher than for CT-FFR (0.84 vs. 0.70) (p = 0.04). The inter-observer and intra-observer variabilities of subtraction CT-FFR were 0.76 and 0.75, respectively. In patients with severe calcification, subtraction CT-FFR had an incremental diagnostic value over CT-FFR, increasing the specificity and PPV while maintaining the sensitivity and NPV with high reproducibility.
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Affiliation(s)
- Yuki Kamo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.K.); (Y.O.N.); (C.A.); (Y.O.K.); (T.D.); (A.K.); (D.T.); (K.T.); (M.H.); (I.O.); (S.O.); (T.M.)
| | - Shinichiro Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.K.); (Y.O.N.); (C.A.); (Y.O.K.); (T.D.); (A.K.); (D.T.); (K.T.); (M.H.); (I.O.); (S.O.); (T.M.)
- Correspondence: ; Tel.: +81-3-5802-1056
| | - Yui O. Nozaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.K.); (Y.O.N.); (C.A.); (Y.O.K.); (T.D.); (A.K.); (D.T.); (K.T.); (M.H.); (I.O.); (S.O.); (T.M.)
| | - Chihiro Aoshima
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.K.); (Y.O.N.); (C.A.); (Y.O.K.); (T.D.); (A.K.); (D.T.); (K.T.); (M.H.); (I.O.); (S.O.); (T.M.)
| | - Yuko O. Kawaguchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.K.); (Y.O.N.); (C.A.); (Y.O.K.); (T.D.); (A.K.); (D.T.); (K.T.); (M.H.); (I.O.); (S.O.); (T.M.)
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.K.); (Y.O.N.); (C.A.); (Y.O.K.); (T.D.); (A.K.); (D.T.); (K.T.); (M.H.); (I.O.); (S.O.); (T.M.)
| | - Ayako Kudo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.K.); (Y.O.N.); (C.A.); (Y.O.K.); (T.D.); (A.K.); (D.T.); (K.T.); (M.H.); (I.O.); (S.O.); (T.M.)
| | - Daigo Takahashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.K.); (Y.O.N.); (C.A.); (Y.O.K.); (T.D.); (A.K.); (D.T.); (K.T.); (M.H.); (I.O.); (S.O.); (T.M.)
| | - Kazuhisa Takamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.K.); (Y.O.N.); (C.A.); (Y.O.K.); (T.D.); (A.K.); (D.T.); (K.T.); (M.H.); (I.O.); (S.O.); (T.M.)
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.K.); (Y.O.N.); (C.A.); (Y.O.K.); (T.D.); (A.K.); (D.T.); (K.T.); (M.H.); (I.O.); (S.O.); (T.M.)
| | - Iwao Okai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.K.); (Y.O.N.); (C.A.); (Y.O.K.); (T.D.); (A.K.); (D.T.); (K.T.); (M.H.); (I.O.); (S.O.); (T.M.)
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.K.); (Y.O.N.); (C.A.); (Y.O.K.); (T.D.); (A.K.); (D.T.); (K.T.); (M.H.); (I.O.); (S.O.); (T.M.)
| | - Nobuo Tomizawa
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (N.T.); (K.K.K.); (S.A.)
| | - Kanako K. Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (N.T.); (K.K.K.); (S.A.)
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (N.T.); (K.K.K.); (S.A.)
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.K.); (Y.O.N.); (C.A.); (Y.O.K.); (T.D.); (A.K.); (D.T.); (K.T.); (M.H.); (I.O.); (S.O.); (T.M.)
- Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo 100-0004, Japan
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10
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Tomizawa N, Kumamaru KK, Okamoto K, Aoki S. Multi-agent system collision model to predict the transmission of seasonal influenza in Tokyo from 2014-2015 to 2018-2019 seasons. Heliyon 2021; 7:e07859. [PMID: 34485738 PMCID: PMC8391024 DOI: 10.1016/j.heliyon.2021.e07859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/20/2021] [Accepted: 08/19/2021] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to apply the multi-agent system (MAS) collision model to predict seasonal influenza epidemic in Tokyo for 5 seasons (2014-2015 to 2018-2019 seasons). The MAS collision model assumes each individual as a particle inside a square domain. The particles move within the domain and disease transmission occurs in a certain probability when an infected particle collides a susceptible particle. The probability was determined based on the basic reproduction number calculated using the actual data. The simulation started with 1 infected particle and 999 susceptible particles to correspond to the onset of an influenza epidemic. We performed the simulation for 150 days and the calculation was repeated 500 times for each season. To improve the accuracy of the prediction, we selected simulations which have similar incidence number to the actual data in specific weeks. Analysis including all simulations corresponded good to the actual data in 2014-2015 and 2015-2016 seasons. However, the model failed to predict the sharp peak incidence after the New Year Holidays in 2016-2017, 2017-2018, and 2018-2019 seasons. A model which included simulations selected by the week of peak incidence predicted the week and number of peak incidence better than a model including all simulations in all seasons. The reproduction number was also similar to the actual data in this model. In conclusion, the MAS collision model predicted the epidemic curve with good accuracy by selecting the simulations using the actual data without changing the initial parameters such as the basic reproduction number and infection time.
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Affiliation(s)
- Nobuo Tomizawa
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koh Okamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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11
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Kumamaru KK, Fujimoto S, Otsuka Y, Kawasaki T, Kawaguchi Y, Kato E, Takamura K, Aoshima C, Kamo Y, Kogure Y, Inage H, Daida H, Aoki S. Diagnostic accuracy of 3D deep-learning-based fully automated estimation of patient-level minimum fractional flow reserve from coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2021; 21:437-445. [PMID: 31230076 DOI: 10.1093/ehjci/jez160] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/15/2019] [Accepted: 06/08/2019] [Indexed: 02/06/2023] Open
Abstract
AIMS Although deep-learning algorithms have been used to compute fractional flow reserve (FFR) from coronary computed tomography angiography (CCTA), no study has achieved 'fully automated' (i.e. free from human input) FFR calculation using deep-learning algorithms. The purpose of the study was to evaluate the accuracy of a fully automated 3D deep-learning model for estimating minimum FFR from CCTA data, with invasive FFR as the reference standard. METHODS AND RESULTS This retrospective study of 1052 patients included 131 patients whose CCTA studies showed 30-90% stenosis and underwent invasive FFR (abnormal FFR observed in 72/131, 55%), and 921 patients who underwent clinically indicated CCTA without invasive FFR. We designed a fully automated 3D deep-learning model that inputs CCTA data and outputs minimum FFR without requiring human input. The model comprised a series of deep-learning algorithms: a conditional generative adversarial network, a 3D convolutional ladder network, and two independent neural networks with integrated virtual adversarial training. We used Monte Carlo cross-validation to evaluate the accuracy of the model for estimating FFR, with invasive FFR as the reference standard. The deep-learning FFR achieved area under the receiver-operating characteristic curve of 0.78 for detection of abnormal FFR; and was significantly higher than for visually determined CCTA >50% stenosis (area under the curve = 0.56). The deep-learning FFR model achieved 76% accuracy for detecting abnormal FFR, with sensitivity of 85% (79-89%) and specificity of 63% (54-70%). CONCLUSION The 3D deep-learning model, which performs fully automatic estimation of minimum FFR from cardiac CT data, achieved 76% accuracy in detecting abnormal FFR.
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Affiliation(s)
- Kanako K Kumamaru
- Department of Radiology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yujiro Otsuka
- Department of Radiology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.,Milliman, Inc., Urbannet Kojimachi Bldg. 8F, 1-6-2 Kojimachi, Chiyoda-ku, Tokyo 102-0083, Japan
| | - Tomohiro Kawasaki
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuko Kawaguchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Etsuro Kato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Chihiro Aoshima
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuki Kamo
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yosuke Kogure
- Department of Radiological Technology, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hidekazu Inage
- Department of Radiological Technology, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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12
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Nozaki YO, Fujimoto S, Aoshima C, Kamo Y, Kawaguchi YO, Takamura K, Kudo A, Takahashi D, Hiki M, Kato Y, Okai I, Dohi T, Okazaki S, Tomizawa N, Kumamaru KK, Aoki S, Minamino T. Comparison of diagnostic performance in on-site based CT-derived fractional flow reserve measurements. Int J Cardiol Heart Vasc 2021; 35:100815. [PMID: 34189251 PMCID: PMC8215214 DOI: 10.1016/j.ijcha.2021.100815] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/17/2021] [Accepted: 05/31/2021] [Indexed: 11/17/2022]
Abstract
Background Computed tomography fractional flow reserve (CT-FFR), which can be acquired on-site workstation using fluid structure interaction during the multiple optimal diastolic phase, has an incremental diagnostic value over conventional coronary computed tomography angiography (CCTA). However, the appropriate location for CT-FFR measurement remains to be clarified. Method A total of 115 consecutive patients with 149 vessels who underwent CCTA showing 30-90% stenosis with invasive FFR within 90 days were retrospectively analyzed. CT-FFR values were measured at three points: 1 and 2 cm distal to the target lesion (CT-FFR1cm, 2cm) and the vessel terminus (CT-FFRlowest). The diagnostic accuracies of CT-FFR ≤ 0.80 for detecting hemodynamically significant stenosis, defined as invasive FFR ≤ 0.80, were compered. Result Fifty-five vessels (36.9%) had invasive FFR ≤ 0.80. The accuracy and AUC for CT-FFR1cm and 2cm were comparable, while the AUC for CT-FFRlowest was significantly lower than CT-FFR1cm and 2cm. (lowest/1cm, 2 cm = 0.68 (95 %CI 0.63-0.73) vs 0.79 (0.72-0.86, p = 0.006), 0.80 (0.73-0.87, p = 0.002)) The sensitivity and negative predictive value of CT-FFRlowest were 100%. The reclassification rates from positive CT-FFRlowest to negative CT-FFR1cm and 2cm were 55.7% and 54.2%, respectively. Conclusion The diagnostic performance of CT-FFR was comparable when measured at 1-to-2 cm distal to the target lesion, but significantly higher than CT-FFRlowest. The lesion-specific CT-FFR could reclassify false positive cases in patients with positive CT-FFRlowest, while all patients with negative CT-FFRlowest were diagnosed as negative by invasive FFR.
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Affiliation(s)
- Yui O Nozaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Chihiro Aoshima
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Kamo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuko O Kawaguchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ayako Kudo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daigo Takahashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshiteru Kato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Iwao Okai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuo Tomizawa
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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13
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Tomizawa N, Chou S, Fujino Y, Matsuoka S, Yamamoto K, Inoh S, Nojo T, Kumamaru KK, Fujimoto S, Nakamura S. Impact of Abnormal Remote Stress Myocardial Blood Flow by Dynamic CT Perfusion on Clinical Outcomes. Sci Rep 2020; 10:10244. [PMID: 32581277 PMCID: PMC7314791 DOI: 10.1038/s41598-020-66992-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/01/2020] [Indexed: 12/05/2022] Open
Abstract
The objective of this study was to investigate the incremental prognostic value for adverse events of myocardial blood flow (MBF) derived from stress computed tomography perfusion (CTP) at remote myocardium over cardiac risk factors and ischemia. We prospectively analyzed 242 patients who underwent dynamic CTP and CT angiography. Adverse events were defined as a composite of all-cause mortality, non-fatal myocardial infarction, unstable angina, heart failure requiring hospitalization, peripheral artery disease, and stroke. MBF value was calculated in each myocardial segment and ischemia was defined as mild decrease in MBF in two consecutive segments or moderate decrease in a single segment accompanied with a coronary stenosis ≥50%. The mean MBF of the non-ischemic segments was defined as remote MBF. We divided the patients into two groups by median MBF value of 1.15 ml/min/g. During a median follow-up of 18 months, 18 patients had adverse events. Annual event rate showed a significant difference between patients with low (≤1.15 ml/min/g) and high (>1.15 ml/min/g) MBF (6.1% vs 1.8%, p = 0.02). Univariate analysis showed that low MBF was a significant predictor of events (hazard ratio (HR): 3.4; 95% confidence interval (CI): 1.2 to 12.0; p = 0.02). This relationship maintained significant after adjusted for the presence of ischemia and cardiac risk factors (HR: 3.0; 95%CI: 1.1 to 11.1; p = 0.04). In conclusion, MBF value ≤1.15 ml/min/g derived from dynamic CTP in remote myocardium is significantly related with poor outcome and this relationship was independent of myocardial ischemia and cardiac risk factors.
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14
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Aoshima C, Fujimoto S, Kawaguchi YO, Dohi T, Kamo Y, Takamura K, Hiki M, Kato Y, Okai I, Okazaki S, Kumamaru KK, Aoki S, Daida H. Plaque characteristics on coronary CT angiography associated with the positive findings of fractional flow reserve and instantaneous wave-free ratio. Heart Vessels 2020; 36:461-471. [PMID: 33219413 DOI: 10.1007/s00380-020-01722-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/30/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are useful in determining indications for revascularization of coronary artery disease (CAD). Although the discordance of FFR and iFR was noted in approximately 20%, this cause has not been well established. We investigated patient background and features on coronary CT angiography (CCTA) showing not only FFR- and iFR-positive findings but also discordance between FFR ≤ 0.8 and iFR ≤ 0.89. METHODS Subjects were consecutively treated in 83 cases with 105 vessels in which stenosis of 30-90% was detected at one vessel of at least 2 mm or more in the major epicardial vessels and FFR and iFR was performed within subsequent 90 days, among suspected CAD which underwent CCTA. The factors affecting not only FFR- and iFR-positive findings, respectively, but also discordance between FFR and iFR was evaluated using logistic regression analysis on per-patient and per-vessel basis. RESULTS FFR- and iFR-positive findings were observed in 42 vessels (40.0%) and 34 vessels (32.3%), respectively. Discordance between FFR ≤ 0.8 and iFR ≤ 0.89 was observed in 22 vessels (21.0%) of 21 patients. In multivariate logistic analysis, LAD (OR 3.55; 95%CI 1.20-11.71; p = 0.0217) and lumen volume/myocardial weight (L/M) ratio (OR 0.93; 0.86-0.99, p = 0.0290) were significant predictors for FFR-positive findings. For iFR-positive findings, LAD (OR 3.86; 95%CI 1.12-13.31; p = 0.0236) was only significant predictor. In FFR ≤ 0.8 and iFR > 0.89 group (15 vessels, 14.3%), positive remodeling (PR) (OR 5.03, 95%CI 1.23-20.48, p = 0.0205) was significant predictor. In FFR > 0.8 and iFR ≤ 0.89 group (7 vessels, 6.7%), there were no significant predictors. CONCLUSION On CCTA characteristics, a relevant predictor for FFR-positive findings included low L/M ratio. PR was significant predictor in FFR-positive, iFR-negative patients among those with discordance between the FFR and iFR.
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Affiliation(s)
- Chihiro Aoshima
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Yuko O Kawaguchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuki Kamo
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Makoto Hiki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yoshiteru Kato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Iwao Okai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
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15
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Podgorsak AR, Sommer KN, Reddy A, Iyer V, Wilson MF, Rybicki FJ, Mitsouras D, Sharma U, Fujimoto S, Kumamaru KK, Angel E, Ionita CN. Initial evaluation of a convolutional neural network used for noninvasive assessment of coronary artery disease severity from coronary computed tomography angiography data. Med Phys 2020; 47:3996-4004. [DOI: 10.1002/mp.14339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alexander R. Podgorsak
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Kelsey N. Sommer
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Abhinay Reddy
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Vijay Iyer
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Michael F. Wilson
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Frank J. Rybicki
- Department of Radiology University of Cincinnati 234 Goodman Street Cincinnati OH USA
| | - Dimitrios Mitsouras
- San Francisco Department of Radiology and Biomedical Imaging University of California 505 Parnassus Avenue San Francisco CA 94143USA
| | - Umesh Sharma
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Shinchiro Fujimoto
- Department of Cardiovascular Medicine Juntendo University 3‐1‐3 Hongo, Bunkyo‐ku Tokyo Japan
| | - Kanako K. Kumamaru
- Department of Radiology Juntendo University 3‐1‐3 Hongo, Bunkyo‐ku Tokyo Japan
| | - Erin Angel
- Canon Medical Systems USA, Inc. 2441 Michelle Drive Tustin CA 92780USA
| | - Ciprian N. Ionita
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
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16
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Kamo Y, Fujimoto S, Aoshima C, Kawaguchi YO, Nozaki Y, Kudo A, Takahashi D, Takamura K, Hiki M, Tomizawa N, Kumamaru KK, Aoki S, Daida H. A study on the prevalence, distribution and related factors of heart valve calcification using coronary CT angiography. Int J Cardiol Heart Vasc 2020; 29:100571. [PMID: 32642552 PMCID: PMC7334460 DOI: 10.1016/j.ijcha.2020.100571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/31/2020] [Accepted: 06/10/2020] [Indexed: 11/25/2022]
Abstract
Background The concept of active atherosclerotic disease has been accepted for heart valve calcification (HVC). We investigated prevalence, distribution and related factors of HVC in patients who had undergone coronary CT angiography (CCTA). Methods Subjects were consecutive 200 patients who underwent CCTA. The prevalence and the distribution of HVC using ECG gated non-contrast CT were investigated. Logistic regression analysis and simple regression analysis for factors associated with presence of the calcification and quantitative calcification in the aortic and mitral valve were conducted. Results HVC was detected in 48.0%. Aortic valve calcification (AVC) was found in 92 cases, the most, followed by mitral valve calcification (MVC) in 25 cases, pulmonary valve in 3 cases, and tricuspid valve in 1 case. Although the left coronary cusp showed the most in 65.2%, no statistic significant difference for Agatston score was detected among each cusp in AVC. Multiple logistic regression analysis showed that age (OR:1.211, 95%C.I.:1.0716-1.1728, p < 0.0001) and coronary artery calcium score (CACS) grade (grade2 OR:7.3393, 95%C.I.:1.7699-30.4349, p = 0.0060, grade3 OR:7.2214, 95%C.I.:1.4376-36.2762, p = 0.0164) were significant factors associated with presence of AVC. The significant factors associated with quantitative AVC were age (p = 0.0043), dyslipidemia (p = 0.0117), and statin use (p = 0.0221). Only age (OR:1.1589, 95%C.I.:1.0726-1.2520, p = 0.0002) was significant factor related to presence of MVC. No significant related factor was found in quantitative MVC. Conclusions There was an association between presence of AVC and CACS, but not a significant association with presence of MVC. Neither quantitative AVC nor MVC had a significant association with CACS or coronary artery disease.
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Affiliation(s)
- Yuki Kamo
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Chihiro Aoshima
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuko O Kawaguchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yui Nozaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ayako Kudo
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daigo Takahashi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Hiki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuo Tomizawa
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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17
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Andica C, Kamagata K, Hatano T, Saito Y, Uchida W, Ogawa T, Takeshige-Amano H, Hagiwara A, Murata S, Oyama G, Shimo Y, Umemura A, Akashi T, Wada A, Kumamaru KK, Hori M, Hattori N, Aoki S. Neurocognitive and psychiatric disorders-related axonal degeneration in Parkinson's disease. J Neurosci Res 2020; 98:936-949. [PMID: 32026517 PMCID: PMC7154645 DOI: 10.1002/jnr.24584] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/05/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022]
Abstract
Neurocognitive and psychiatric disorders have significant consequences for quality of life in patients with Parkinson's disease (PD). In the current study, we evaluated microstructural white matter (WM) alterations associated with neurocognitive and psychiatric disorders in PD using neurite orientation dispersion and density imaging (NODDI) and linked independent component analysis (LICA). The indices of NODDI were compared between 20 and 19 patients with PD with and without neurocognitive and psychiatric disorders, respectively, and 25 healthy controls using tract‐based spatial statistics and tract‐of‐interest analyses. LICA was applied to model inter‐subject variability across measures. A widespread reduction in axonal density (indexed by intracellular volume fraction [ICVF]) was demonstrated in PD patients with and without neurocognitive and psychiatric disorders, as compared with healthy controls. Compared with patients without neurocognitive and psychiatric disorders, patients with neurocognitive and psychiatric disorders exhibited more extensive (posterior predominant) decreases in axonal density. Using LICA, ICVF demonstrated the highest contribution (59% weight) to the main effects of diagnosis that reflected widespread decreases in axonal density. These findings suggest that axonal loss is a major factor underlying WM pathology related to neurocognitive and psychiatric disorders in PD, whereas patients with neurocognitive and psychiatric disorders had broader axonal pathology, as compared with those without. LICA suggested that the ICVF can be used as a useful biomarker of microstructural changes in the WM related to neurocognitive and psychiatric disorders in PD.
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Affiliation(s)
- Christina Andica
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taku Hatano
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuya Saito
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Wataru Uchida
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Takashi Ogawa
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Akifumi Hagiwara
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Syo Murata
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Genko Oyama
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yashushi Shimo
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Umemura
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshiaki Akashi
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akihiko Wada
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masaaki Hori
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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18
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Cai T, Zhang L, Yang N, Kumamaru KK, Rybicki FJ, Cai T, Liao KP. EXTraction of EMR numerical data: an efficient and generalizable tool to EXTEND clinical research. BMC Med Inform Decis Mak 2019; 19:226. [PMID: 31730484 PMCID: PMC6858776 DOI: 10.1186/s12911-019-0970-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 11/06/2019] [Indexed: 11/12/2022] Open
Abstract
Background Electronic medical records (EMR) contain numerical data important for clinical outcomes research, such as vital signs and cardiac ejection fractions (EF), which tend to be embedded in narrative clinical notes. In current practice, this data is often manually extracted for use in research studies. However, due to the large volume of notes in datasets, manually extracting numerical data often becomes infeasible. The objective of this study is to develop and validate a natural language processing (NLP) tool that can efficiently extract numerical clinical data from narrative notes. Results To validate the accuracy of the tool EXTraction of EMR Numerical Data (EXTEND), we developed a reference standard by manually extracting vital signs from 285 notes, EF values from 300 notes, glycated hemoglobin (HbA1C), and serum creatinine from 890 notes. For each parameter of interest, we calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and F1 score of EXTEND using two metrics. (1) completion of data extraction, and (2) accuracy of data extraction compared to the actual values in the note verified by chart review. At the note level, extraction by EXTEND was considered correct only if it accurately detected and extracted all values of interest in a note. Using manually-annotated labels as the gold standard, the note-level accuracy of EXTEND in capturing the numerical vital sign values, EF, HbA1C and creatinine ranged from 0.88 to 0.95 for sensitivity, 0.95 to 1.0 for specificity, 0.95 to 1.0 for PPV, 0.89 to 0.99 for NPV, and 0.92 to 0.96 in F1 scores. Compared to the actual value level, the sensitivity, PPV, and F1 score of EXTEND ranged from 0.91 to 0.95, 0.95 to 1.0 and 0.95 to 0.96. Conclusions EXTEND is an efficient, flexible tool that uses knowledge-based rules to extract clinical numerical parameters with high accuracy. By increasing dictionary terms and developing new rules, the usage of EXTEND can easily be expanded to extract additional numerical data important in clinical outcomes research.
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Affiliation(s)
- Tianrun Cai
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, 6016BB, 60 Fenwood Road, Boston, 02115, USA. .,Harvard Medical School, Boston, MA, USA.
| | | | - Nicole Yang
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, 6016BB, 60 Fenwood Road, Boston, 02115, USA
| | - Kanako K Kumamaru
- Department of Radiology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Frank J Rybicki
- Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Tianxi Cai
- Harvard Medical School, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Katherine P Liao
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, 6016BB, 60 Fenwood Road, Boston, 02115, USA.,Harvard Medical School, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA
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19
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Kumamaru KK, Angel E, Sommer KN, Iyer V, Wilson MF, Agrawal N, Bhardwaj A, Kattel SB, Kondziela S, Malhotra S, Manion C, Pogorzelski K, Ramanan T, Sawant AC, Suplicki MM, Waheed S, Fujimoto S, Sharma UC, Rybicki FJ, Ionita CN. Inter- and Intraoperator Variability in Measurement of On-Site CT-derived Fractional Flow Reserve Based on Structural and Fluid Analysis: A Comprehensive Analysis. Radiol Cardiothorac Imaging 2019; 1:e180012. [PMID: 33778507 DOI: 10.1148/ryct.2019180012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/17/2019] [Accepted: 06/24/2019] [Indexed: 11/11/2022]
Abstract
Purpose To measure the inter- and intraobserver variability among operators of varying expertise in conducting CT-derived fractional flow reserve (CT FFR) measurements on-site by using structural and fluid analysis and to evaluate differences in reproducibility between two different training methods for end users. Materials and Methods This retrospective analysis of the prospectively enrolled cohort included 22 symptomatic patients who underwent both 320-detector row coronary CT angiography and catheter-derived fractional flow reserve (FFR) within 90 days. Thirteen operators of varying expertise were assigned to one of two training arms: arm 1, on-site training by a specialist in CT FFR technology; arm 2, self-training through use of written materials. After the training, all 13 operators reviewed the CT data and measured CT FFR in 24 vessels in 22 patients. Inter- and intraoperator variability and agreements between CT FFR and catheter-derived FFR measurements were evaluated. Results The overall intraclass correlation coefficient (ICC) among operators was 0.71 (95% confidence interval: 0.58, 0.83) with a mean absolute difference (± standard deviation) of 0.027 ± 0.022. The operators in arm 2 showed greater interoperator differences than those in arm 1 (0.031 ± 0.024 vs 0.023 ± 0.018; P = .024). Among operators who recalculated CT FFR, the mean CT FFR value did not significantly differ between the first and second calculations (ICC, 0.66; 95% confidence interval: 0.46, 0.87), with the medical specialists producing the lowest intraoperator variability (0.053 ± 0.060). The overall correlation coefficient between CT FFR and catheter FFR was r = 0.61, with a mean absolute difference of 0.096 ± 0.089. Conclusion Good reproducibility of CT FFR values calculated on-site on the basis of structural and fluid analysis was observed among operators of varying expertise. Face-to-face training sessions may cause less variability.© RSNA, 2019Supplemental material is available for this article.
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Affiliation(s)
- Kanako K Kumamaru
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Erin Angel
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Kelsey N Sommer
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Vijay Iyer
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Michael F Wilson
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Nikhil Agrawal
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Aishwarya Bhardwaj
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Sharma B Kattel
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Sandra Kondziela
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Saurabh Malhotra
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Christopher Manion
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Katherine Pogorzelski
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Tharmathai Ramanan
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Abhishek C Sawant
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Mary M Suplicki
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Sameer Waheed
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Shinichiro Fujimoto
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Umesh C Sharma
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Frank J Rybicki
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Ciprian N Ionita
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
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20
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Andica C, Kamagata K, Hatano T, Saito A, Uchida W, Ogawa T, Takeshige-Amano H, Zalesky A, Wada A, Suzuki M, Hagiwara A, Irie R, Hori M, Kumamaru KK, Oyama G, Shimo Y, Umemura A, Pantelis C, Hattori N, Aoki S. Free-Water Imaging in White and Gray Matter in Parkinson's Disease. Cells 2019; 8:cells8080839. [PMID: 31387313 PMCID: PMC6721691 DOI: 10.3390/cells8080839] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/29/2019] [Accepted: 08/03/2019] [Indexed: 11/16/2022] Open
Abstract
This study aimed to discriminate between neuroinflammation and neuronal degeneration in the white matter (WM) and gray matter (GM) of patients with Parkinson’s disease (PD) using free-water (FW) imaging. Analysis using tract-based spatial statistics (TBSS) of 20 patients with PD and 20 healthy individuals revealed changes in FW imaging indices (i.e., reduced FW-corrected fractional anisotropy (FAT), increased FW-corrected mean, axial, and radial diffusivities (MDT, ADT, and RDT, respectively) and fractional volume of FW (FW) in somewhat more specific WM areas compared with the changes of DTI indices. The region-of-interest (ROI) analysis further supported these findings, whereby those with PD showed significantly lower FAT and higher MDT, ADT, and RDT (indices of neuronal degeneration) in anterior WM areas as well as higher FW (index of neuroinflammation) in posterior WM areas compared with the controls. Results of GM-based spatial statistics (GBSS) analysis revealed that patients with PD had significantly higher MDT, ADT, and FW than the controls, whereas ROI analysis showed significantly increased MDT and FW and a trend toward increased ADT in GM areas, corresponding to Braak stage IV. These findings support the hypothesis that neuroinflammation precedes neuronal degeneration in PD, whereas WM microstructural alterations precede changes in GM.
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Affiliation(s)
- Christina Andica
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.
| | - Taku Hatano
- Department of Neurology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Asami Saito
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Wataru Uchida
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Department of Radiological Sciences, Tokyo Metropolitan University, Graduate School of Human Health Sciences, Tokyo 116-8551, Japan
| | - Takashi Ogawa
- Department of Neurology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | | | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Parkville, VIC 3053, Australia
- Melbourne School of Engineering, The University of Melbourne, VIC 3010, Australia
| | - Akihiko Wada
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Michimasa Suzuki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Ryusuke Irie
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Department of Radiology, The University of Tokyo Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Masaaki Hori
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Department of Radiology, Toho University Omori Medical Center, Tokyo 143-8541, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Genko Oyama
- Department of Neurology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Yashushi Shimo
- Department of Neurology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Atsushi Umemura
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Parkville, VIC 3053, Australia
- Melbourne School of Engineering, The University of Melbourne, VIC 3010, Australia
- Florey Institute for Neuroscience and Mental Health, Parkville, VIC 3052, Australia
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
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21
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Kawaguchi YO, Fujimoto S, Kumamaru KK, Kato E, Dohi T, Takamura K, Aoshima C, Kamo Y, Kato Y, Hiki M, Okai I, Okazaki S, Aoki S, Daida H. The predictive factors affecting false positive in on-site operated CT-fractional flow reserve based on fluid and structural interaction. Int J Cardiol Heart Vasc 2019; 23:100372. [PMID: 31193109 PMCID: PMC6517572 DOI: 10.1016/j.ijcha.2019.100372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/15/2019] [Accepted: 05/02/2019] [Indexed: 12/05/2022]
Abstract
Background A novel algorithm has been developed for the on-site analysis of CT-fractional flow reserve (CT-FFR) using fluid structural interactions. There have been no reports on the factors affecting the diagnostic performance of CT-FFR using this algorithm. We evaluated the factors predictive of false-positive CT-FFR findings compared to invasive FFR as a reference standard. Methods The subjects were 66 consecutive cases (81 vessels) who underwent invasive FFR assessment within 90 days of the detection of 30–90% stenosis of one vessel of the major coronary artery, from among patients with suspected coronary arterial disease who underwent one-rotation scanning by 320-row coronary CT angiography (CCTA). The prospective CCTA mode was used for all patients, with the X-ray exposure set in a range of 70–99% of the RR interval. The FFR was calculated on-site from multiple cardiac phases. Factors associated with a false-positive finding of functional stenosis on CT-FFR, defined as an invasive FFR of ≤0.80, were evaluated using logistic regression analysis. Results Thirty-nine vessels (48.1%) had an invasive FFR of ≤0.80. CT-FFR and invasive FFR values disagreed in 13 vessels in 13 patients. The values were false positive in 12 of the vessels. In an analysis of patient characteristics, the body mass index (odds ratio, 1.33; 95%CI, 1.06–1.67; p = 0.01) and Image noise (odds ratio, 1.18; 95%CI, 1.01–1.40; p = 0.04) were predictive of false-positive findings. The presence of calcified plaque (odds ratio, 5.16; 95%CI, 1.06–20.85; p = 0.01) was the only significant predictive factor in a vessel-based analysis of lesion characteristics. Conclusions The presence of calcified plaque exerted a significant effect on the diagnostic performance of CT-FFR, and did so independently of the degree of calcification indicated by the Agatston score.
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Affiliation(s)
- Yuko O Kawaguchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Etsuro Kato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Chihiro Aoshima
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Kamo
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshiteru Kato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Hiki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Iwao Okai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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22
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Kumamaru KK, Kumamaru H, Yasunaga H, Matsui H, Omiya T, Hori M, Suzuki M, Wada A, Kamagata K, Takamura T, Irie R, Nakanishi A, Aoki S. Large hospital variation in the utilization of Post-procedural CT to detect pulmonary embolism/Deep Vein Thrombosis in Patients Undergoing Total Knee or Hip Replacement Surgery: Japanese Nationwide Diagnosis Procedure Combination Database Study. Br J Radiol 2019; 92:20180825. [PMID: 30835500 DOI: 10.1259/bjr.20180825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The purpose of the study was to investigate variation in the use of in-hospital CT for venous thromboembolism (VTE) detection after total knee or hip replacement (TKR/THR) among surgical patients, using a nationwide Japanese in-hospital administrative database. METHODS This retrospective study using a national administrative database (4/2012-3/2013) extracted patients who underwent TKR/THR surgeries at hospitals meeting the annual case-volume threshold of ≥ 30. Hospitals were categorized into three equally sized groups by frequency of postoperative CT use (low, middle, and high CT use group) to compare baseline patient-level and hospital-level characteristics. To further investigate between-hospital variation in CT usage, we fitted a hierarchical logistic regression model including hospital-specific random intercepts and fixed patient- and hospital-level effects. The intra class correlation coefficient was used to measure the amount of variability in CT use attributable to between-hospital variation. RESULTS A total of 39,127 patients discharged from 447 hospitals met the inclusion criteria. The median hospital stay was 25 days (interquartile range, 20 - 32) and 7,599 (19.4%) patients underwent CT for VTE. CT utilization varied greatly among the hospitals; the crude frequency ranged from 0 to 100 % (median, 7.3 %; interquartile range, 1.8 - 18.3 %). After adjustment for known hospital- and patient-level factors related to CT use, 47 % of the variation in CT use remained attributable to the behavior of individual hospitals. CONCLUSION We observed large inter hospital variability in the utilization of post-procedure CT for VTE detection in this Japanese TKR/THR cohort, suggesting that CT utilization is not optimized across the nation. ADVANCES IN KNOWLEDGE We observed significant variability in the utilization of post-procedure CT for VTE detection among inpatients who underwent TKR/THR surgeries in a large sample of Japanese hospitals. The large variation suggests that CT utilization is not optimized across the nation, and that there may be potential overutilization of the technology in the highest CT use hospitals.
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Affiliation(s)
| | - Hiraku Kumamaru
- 2 Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo , Tokyo , Japan
| | - Hideo Yasunaga
- 3 Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo , Japan
| | - Hiroki Matsui
- 3 Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo , Japan
| | - Toshinobu Omiya
- 4 Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo , Japan
| | - Masaaki Hori
- 1 Department of Radiology, Juntendo University , Tokyo , Japan
| | | | - Akihiko Wada
- 1 Department of Radiology, Juntendo University , Tokyo , Japan
| | - Koji Kamagata
- 1 Department of Radiology, Juntendo University , Tokyo , Japan
| | | | - Ryusuke Irie
- 1 Department of Radiology, Juntendo University , Tokyo , Japan
| | | | - Shigeki Aoki
- 1 Department of Radiology, Juntendo University , Tokyo , Japan
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23
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Fujimoto S, Kawasaki T, Kumamaru KK, Kawaguchi Y, Dohi T, Okonogi T, Ri K, Yamada S, Takamura K, Kato E, Kato Y, Hiki M, Okazaki S, Aoki S, Mitsouras D, Rybicki FJ, Daida H. Diagnostic performance of on-site computed CT-fractional flow reserve based on fluid structure interactions: comparison with invasive fractional flow reserve and instantaneous wave-free ratio. Eur Heart J Cardiovasc Imaging 2018; 20:343-352. [DOI: 10.1093/ehjci/jey104] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/23/2018] [Accepted: 07/03/2018] [Indexed: 01/10/2023] Open
Affiliation(s)
- Shinichiro Fujimoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, Japan
| | - Tomonori Kawasaki
- Department of Cardiovascular Medicine, Shin-Koga Hospital, Kurume, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuko Kawaguchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, Japan
| | - Taichi Okonogi
- Department of Cardiovascular Medicine, Shin-Koga Hospital, Kurume, Japan
| | - Keiken Ri
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Sou Yamada
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, Japan
| | - Etsuro Kato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, Japan
| | - Yoshiteru Kato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, Japan
| | - Makoto Hiki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, Japan
| | - Shigeki Aoki
- Department of Cardiovascular Medicine, Shin-Koga Hospital, Kurume, Japan
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Dimitris Mitsouras
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, The University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Frank J Rybicki
- Department of Radiology, The University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, Japan
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Fujimoto S, Giannopoulos AA, Kumamaru KK, Matsumori R, Tang A, Kato E, Kawaguchi Y, Takamura K, Miyauchi K, Daida H, Rybicki FJ, Mitsouras D. The transluminal attenuation gradient in coronary CT angiography for the detection of hemodynamically significant disease: can all arteries be treated equally? Br J Radiol 2018; 91:20180043. [PMID: 29589976 DOI: 10.1259/bjr.20180043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Results of the use of the transluminal attenuation gradient (TAG) at coronary CT angiography (CCTA) to predict hemodynamically significant disease vary widely. This study tested whether diagnostic performance of TAG to predict fractional flow reserve (FFR) ≤ 0.8 is improved when applied separately to subsets of coronary arteries that carry similar physiological flow. METHODS 28 patients with 64 × 0.5 mm CCTA and invasive FFR in ≥1 major coronary artery were retrospectively evaluated. Two readers assessed TAG in each artery. The receiver operating characteristic (ROC) area under the curve (AUC) was used to assess the diagnostic performance of TAG to detect hemodynamically significant disease following a clinical use rule [negative: FFR > 0.8 or ≤ 25% diameter stenosis (DS) at invasive catheter angiography; positive: FFR ≤ 0.8 or ≥ 90% DS at invasive catheter angiography]. ROC AUC was compared for all arteries pooled together, vs separately for arteries carrying similar physiological flow (Group 1: all left anterior descending plus right-dominant left circumflex; Group 2: right-dominant RCA plus left/co-dominant left circumflex). RESULTS Of the 84 arteries, 30 had FFR measurements, 30 had ≤25% DS and 13 had ≥90% DS. 11 arteries with 26-89% DS and no FFR measurement were excluded. TAG interobserver reproducibility was excellent (Pearson r = 0.954, Bland-Altman bias: 0.224 Hounsfield unit cm-1). ROC AUC to detect hemodynamically significant disease was higher when considering arteries separately (Group 1 AUC = 0.841, p = 0.039; Group 2 AUC = 0.840, p = 0.188), than when pooling all arteries together (AUC = 0.661). CONCLUSION Incorporating information on the physiology of coronary flow via the particular vessel interrogated and coronary dominance may improve the accuracy of TAG, a simple measurement that can be quickly performed at the time of CCTA interpretation to detect hemodynamically significant stenosis in individual coronary arteries. Advances in knowledge: The interpretation of TAG may benefit by incorporating information regarding which coronary artery is being interrogated.
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Affiliation(s)
- Shinichiro Fujimoto
- 1 Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Andreas A Giannopoulos
- 2 Department of Radiology, Applied Imaging Science Laboratory, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA.,3 Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich , Zurich , Switzerland
| | - Kanako K Kumamaru
- 2 Department of Radiology, Applied Imaging Science Laboratory, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA.,4 Department of Radiology, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Rie Matsumori
- 1 Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Anji Tang
- 2 Department of Radiology, Applied Imaging Science Laboratory, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Etsuro Kato
- 1 Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Yuko Kawaguchi
- 1 Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Kazuhisa Takamura
- 1 Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Katsumi Miyauchi
- 1 Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Hiroyuki Daida
- 1 Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Frank J Rybicki
- 5 The Ottawa Hospital Research Institute , Ottawa, ON , Canada.,6 Department of Radiology, The University of Ottawa , Ottawa, ON , Canada
| | - Dimitris Mitsouras
- 2 Department of Radiology, Applied Imaging Science Laboratory, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA.,5 The Ottawa Hospital Research Institute , Ottawa, ON , Canada.,7 Department of Biochemistry, Microbiology and Immunology, The University of Ottawa , Ottawa, ON , Canada
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Kumamaru KK, Machitori A, Koba R, Ijichi S, Nakajima Y, Aoki S. Correction to: Global and Japanese regional variations in radiologist potential workload for computed tomography and magnetic resonance imaging examinations. Jpn J Radiol 2018; 36:282-284. [DOI: 10.1007/s11604-018-0730-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Kumamaru KK, Machitori A, Koba R, Ijichi S, Nakajima Y, Aoki S. Global and Japanese regional variations in radiologist potential workload for computed tomography and magnetic resonance imaging examinations. Jpn J Radiol 2018; 36:273-281. [PMID: 29453512 DOI: 10.1007/s11604-018-0724-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/05/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE To investigate the global variation in radiologist potential workload for CT and MRI examinations, and the regional variation in potential workload and extent of radiologists' involvement in CT and MRI examinations in Japan. METHODS "Radiologist potential workload" was defined as the annual number of CT plus MRI examinations divided by the total number of diagnostic radiologists. The extent of radiologists' involvement was measured as the proportion of CT and MRI examinations to which "Added-fees for Radiological Managements on Imaging-studies (ARMIs)" were applied among eligible examinations. Maximum variation was computed as the ratio of the highest-to-lowest values among the countries or Japanese prefectures. RESULTS The radiologist potential workload in Japan was 2.78-4.17 times higher than those in other countries. A maximum prefecture-to-prefecture variation was 3.88. The average percentage of CT plus MRI examinations with ARMI applied was 43.3%, with a maximum prefecture-to-prefecture variation of 3.97. Prefectures with more radiologists tended to have a higher extent of radiologists' involvement. CONCLUSIONS Japan had a far greater radiologist potential workload compared with other countries, with a large regional variation among prefectures. Prefectures with more radiologists tended to have a higher extent of radiologists' involvement in CT and MRI examinations.
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Affiliation(s)
- Kanako K Kumamaru
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Akihiro Machitori
- Department of Radiology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan
| | - Ritsuko Koba
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.,GE Healthcare Japan Corporation, 4-7-127 Asahigaoka, Hino-shi, Tokyo, 191-8503, Japan
| | - Shinpei Ijichi
- GE Healthcare Japan Corporation, 4-7-127 Asahigaoka, Hino-shi, Tokyo, 191-8503, Japan
| | - Yasuo Nakajima
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Shigeki Aoki
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Giannopoulos AA, Tang A, Ge Y, Cheezum MK, Steigner ML, Fujimoto S, Kumamaru KK, Chiappino D, Della Latta D, Berti S, Chiappino S, Rybicki FJ, Melchionna S, Mitsouras D. Diagnostic performance of a Lattice Boltzmann-based method for CT-based fractional flow reserve. EUROINTERVENTION 2018. [DOI: 10.4244/eij-d-17-00019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ri K, Kumamaru KK, Fujimoto S, Kawaguchi Y, Dohi T, Yamada S, Takamura K, Kogure Y, Yamada N, Kato E, Irie R, Takamura T, Suzuki M, Hori M, Aoki S, Daida H. Noninvasive Computed Tomography–Derived Fractional Flow Reserve Based on Structural and Fluid Analysis. J Comput Assist Tomogr 2018; 42:256-262. [DOI: 10.1097/rct.0000000000000679] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Andica C, Hagiwara A, Hori M, Nakazawa M, Goto M, Koshino S, Kamagata K, Kumamaru KK, Aoki S. Automated brain tissue and myelin volumetry based on quantitative MR imaging with various in-plane resolutions. J Neuroradiol 2017; 45:164-168. [PMID: 29132939 DOI: 10.1016/j.neurad.2017.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/14/2017] [Accepted: 10/20/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE Segmented brain tissue and myelin volumes can now be automatically calculated using dedicated software (SyMRI), which is based on quantification of R1 and R2 relaxation rates and proton density. The aim of this study was to determine the validity of SyMRI brain tissue and myelin volumetry using various in-plane resolutions. METHODS We scanned 10 healthy subjects on a 1.5T MR scanner with in-plane resolutions of 0.8, 2.0 and 3.0mm. Two scans were performed for each resolution. The acquisition time was 7-min and 24-sec for 0.8mm, 3-min and 9-sec for 2.0mm and 1-min and 56-sec for 3.0mm resolutions. The volumes of white matter (WM), gray matter (GM), cerebrospinal fluid (CSF), non-WM/GM/CSF (NoN), brain parenchymal volume (BPV), intracranial volume (ICV) and myelin were compared between in-plane resolutions. Repeatability for each resolution was then analyzed. RESULTS No significant differences in volumes measured were found between the different in-plane resolutions, except for NoN between 0.8mm and 2.0mm and between 2.0mm and 3.0mm. The repeatability error value for the WM, GM, CSF, NoN, BPV and myelin volumes relative to ICV was 0.97%, 1.01%, 0.65%, 0.86%, 1.06% and 0.25% in 0.8mm; 1.22%, 1.36%, 0.73%, 0.37%, 1.18% and 0.35% in 2.0mm and 1.18%, 1.02%, 0.96%, 0.45%, 1.36%, and 0.28% in 3.0mm resolutions. CONCLUSION SyMRI brain tissue and myelin volumetry with low in-plane resolution and short acquisition times is robust and has a good repeatability so could be useful for follow-up studies.
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Affiliation(s)
- C Andica
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - A Hagiwara
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan; Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - M Hori
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - M Nakazawa
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - M Goto
- School of Allied Health Sciences, Kitasato University, 1-15-1, Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
| | - S Koshino
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - K Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - K K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - S Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Kamagata K, Zalesky A, Hatano T, Di Biase MA, El Samad O, Saiki S, Shimoji K, Kumamaru KK, Kamiya K, Hori M, Hattori N, Aoki S, Pantelis C. Connectome analysis with diffusion MRI in idiopathic Parkinson's disease: Evaluation using multi-shell, multi-tissue, constrained spherical deconvolution. Neuroimage Clin 2017; 17:518-529. [PMID: 29201640 PMCID: PMC5700829 DOI: 10.1016/j.nicl.2017.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/16/2017] [Accepted: 11/07/2017] [Indexed: 01/08/2023]
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder that affects extensive regions of the central nervous system. In this work, we evaluated the structural connectome of patients with PD, as mapped by diffusion-weighted MRI tractography and a multi-shell, multi-tissue (MSMT) constrained spherical deconvolution (CSD) method to increase the precision of tractography at tissue interfaces. The connectome was mapped with probabilistic MSMT-CSD in 21 patients with PD and in 21 age- and gender-matched controls. Mapping was also performed by deterministic single-shell, single tissue (SSST)-CSD tracking and probabilistic SSST-CSD tracking for comparison. A support vector machine was trained to predict diagnosis based on a linear combination of graph metrics. We showed that probabilistic MSMT-CSD could detect significantly reduced global strength, efficiency, clustering, and small-worldness, and increased global path length in patients with PD relative to healthy controls; by contrast, probabilistic SSST-CSD only detected the difference in global strength and small-worldness. In patients with PD, probabilistic MSMT-CSD also detected a significant reduction in local efficiency and detected clustering in the motor, frontal temporoparietal associative, limbic, basal ganglia, and thalamic areas. The network-based statistic identified a subnetwork of reduced connectivity by MSMT-CSD and probabilistic SSST-CSD in patients with PD, involving key components of the cortico–basal ganglia–thalamocortical network. Finally, probabilistic MSMT-CSD had superior diagnostic accuracy compared with conventional probabilistic SSST-CSD and deterministic SSST-CSD tracking. In conclusion, probabilistic MSMT-CSD detected a greater extent of connectome pathology in patients with PD, including those with cortico–basal ganglia–thalamocortical network disruptions. Connectome analysis based on probabilistic MSMT-CSD may be useful when evaluating the extent of white matter connectivity disruptions in PD. Connectomes mapped in Parkinson's disease (PD) using multi-shell tractography. Multi-shell tractography provided improved sensitivity to connectome pathology. Machine learning accurately predicted PD diagnosis based on connectome. Connectome pathology in PD was localized to basal ganglia-thalamocortical circuits.
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Key Words
- CSD, constrained spherical deconvolution
- CSF, cerebrospinal fluid
- Connectome
- DW-MRI, diffusion-weighted magnetic resonance imaging
- Diffusion MRI
- Diffusion tensor imaging
- GM, gray matter
- Lewy bodies
- MSMT-CSD, multi-shell, multi-tissue CSD
- Neurodegenerative disorders
- PD, Parkinson's disease
- SVM, support vector machine
- Support vector machine
- UPDRS, Unified Idiopathic Parkinson's Disease Rating Scale
- WM, white matter
- fODF, fiber orientation distribution function
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Affiliation(s)
- Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Parkville, VIC, Australia.
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Parkville, VIC, Australia; Melbourne School of Engineering, University of Melbourne, Melbourne, Australia
| | - Taku Hatano
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Maria Angelique Di Biase
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Parkville, VIC, Australia
| | - Omar El Samad
- Department of Computing and Information Systems, University of Melbourne, Parkville, Australia
| | - Shinji Saiki
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Keigo Shimoji
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kouhei Kamiya
- Department of Radiology, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Masaaki Hori
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Parkville, VIC, Australia; Melbourne School of Engineering, University of Melbourne, Melbourne, Australia; Centre for Neural Engineering, Department of Electrical and Electronic Engineering, The University of Melbourne, Carlton, VIC, Australia
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Takamura T, Hori M, Kamagata K, Kumamaru KK, Irie R, Hagiwara A, Hamasaki N, Aoki S. Slice-accelerated gradient-echo echo planar imaging dynamic susceptibility contrast-enhanced MRI with blipped CAIPI: effect of increasing temporal resolution. Jpn J Radiol 2017; 36:40-50. [PMID: 29086345 DOI: 10.1007/s11604-017-0695-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/13/2017] [Indexed: 01/02/2023]
Abstract
PURPOSE To assess the influence of high temporal resolution on the perfusion measurements and image quality of perfusion maps, by applying simultaneous-multi-slice acquisition (SMS) dynamic susceptibility contrast-enhanced (DSC) magnetic resonance imaging (MRI). MATERIALS AND METHODS DSC-MRI data using SMS gradient-echo echo planar imaging sequences in 10 subjects with no intracranial abnormalities were retrospectively analyzed. Three additional data sets with temporal resolution of 1.0, 1.5, and 2.0 s were created from the raw data sets of 0.5 s. Cerebral blood flow (CBF), cerebral blood volume, mean transit time (MTT), time to peak (TTP), and time to maximum tissue residue function (T max) measurements were performed, as was visual perfusion map analysis. The perfusion parameter for temporal resolution of 0.5 s (reference) was compared with each synthesized perfusion parameter. RESULTS CBF, MTT, and TTP values at temporal resolutions of 1.5 and 2.0 s differed significantly from the reference. The image quality of MTT, TTP, and T max maps deteriorated with decreasing temporal resolution. CONCLUSION The temporal resolution of DSC-MRI influences perfusion parameters and SMS DSC-MRI provides better image quality for MTT, TTP, and T max maps.
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Affiliation(s)
- Tomohiro Takamura
- Department of Radiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Masaaki Hori
- Department of Radiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ryusuke Irie
- Department of Radiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Nozomi Hamasaki
- Department of Radiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Kumamaru KK, Sano Y, Kumamaru H, Hori M, Takamura T, Irie R, Suzuki M, Hagiwara A, Kamagata K, Nakanishi A, Aoki S. Radiologist involvement is associated with reduced use of MRI in the acute period of low back pain in a non-elderly population. Eur Radiol 2017; 28:1600-1608. [PMID: 29063252 DOI: 10.1007/s00330-017-5086-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/22/2017] [Accepted: 09/22/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To test the hypothesis that "acute-period" lumbar MRI in non-elderly patients with low back pain is less frequently performed at clinics/hospitals with greater involvement of full-time radiologists in the imaging workflow. METHODS In a national-level claims database, we identified 14,819 non-elderly patients (mean age: 38.7±8.0 years) who visited clinics/hospitals for low back pain in 2013-2015. We classified the clinics/hospitals into four groups based on the level of full-time radiologist involvement and MRI ownership, and compared the frequency of acute-period lumbar MRI using hierarchical logistic regression analysis. RESULTS Patients visiting facilities without a full-time radiologist (n=2105) were significantly (p<0.001) more likely to undergo acute-period MRI than those visiting facilities with ≥1 radiologist partially managing imaging workflow (level-1, n=491) or ≥1 radiologist intensively involved in imaging workflow (level-2, n=1190) (15.7% vs. 6.9% and 7.3%; adjusted odds ratio of no-radiologist versus level-2: 2.93, p=0.018). No difference was observed between level-1 and level-2 involvement. CONCLUSIONS Facilities with no full-time radiologist were more likely to perform acute-period MRI to assess for low back pain, while no difference was seen between facilities with varying levels of radiologist involvement in the imaging workflow. Radiologist involvement may contribute to optimal utilisation of medical imaging. KEY POINTS • Lumbar MRI was more frequently performed at facilities without full-time radiologists. • Full-time radiologists may play an important role in appropriate utilisation of imaging. • Frequency of MRI was similar between moderate and intensive radiologist involvement.
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Affiliation(s)
- Kanako K Kumamaru
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Yukiko Sano
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masaaki Hori
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tomohiro Takamura
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ryusuke Irie
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Michimasa Suzuki
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Akifumi Hagiwara
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Koji Kamagata
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Atsushi Nakanishi
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shigeki Aoki
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Takano N, Suzuki M, Irie R, Yamamoto M, Teranishi K, Yatomi K, Hamasaki N, Kumamaru KK, Hori M, Oishi H, Aoki S. Non-Contrast-Enhanced Silent Scan MR Angiography of Intracranial Anterior Circulation Aneurysms Treated with a Low-Profile Visualized Intraluminal Support Device. AJNR Am J Neuroradiol 2017; 38:1610-1616. [PMID: 28522664 DOI: 10.3174/ajnr.a5223] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/14/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Low-Profile Visualized Intraluminal Support Device comprises a small-cell nitinol structure and a single-wire braided stent that provides greater metal coverage than previously reported intracranial stents, as well as assumed strong susceptibility artifacts. This study aimed to assess the benefits of non-contrast-enhanced MRA by using a Silent Scan (Silent MRA) for intracranial anterior circulation aneurysms treated with Low-Profile Visualized Intraluminal Support Device stents. MATERIALS AND METHODS Thirty-one aneurysms treated with Low-Profile Visualized Intraluminal Support Device stents were assessed by using Silent MRA, 3D TOF-MRA, and x-ray DSA. The quality of MRA visualization of the reconstructed artery was graded on a 4-point scale from 1 (not visible) to 4 (excellent). Aneurysm occlusion status was evaluated by using a 2-grade scale (total occlusion/remnant [neck or aneurysm]). Weighted κ statistics were used to evaluate interobserver and intermodality agreement. RESULTS The mean scores ± SDs for Silent MRA and 3D TOF-MRA were 3.16 ± 0.79 and 1.48 ± 0.67 (P < .05), respectively, with substantial interobserver agreement (κ = 0.66). The aneurysm occlusion rates of the 2-grade scale (total occlusion/remnant [neck or aneurysm]) were 69%/31% for DSA, 65%/35% for Silent MRA, and 92%/8% for 3D TOF-MRA, respectively. The intermodality agreements were 0.88 and 0.30 for DSA/Silent MRA and DSA/3D TOF-MRA, respectively. CONCLUSIONS Silent MRA seems to be useful for visualizing intracranial anterior circulation aneurysms treated with Low-Profile Visualized Intraluminal Support Device stents.
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Affiliation(s)
- N Takano
- From the Department of Radiology (N.T., M.S., K.K.K., M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan .,Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Suzuki
- From the Department of Radiology (N.T., M.S., K.K.K., M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - R Irie
- Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Yamamoto
- Departments of Neurosurgery (M.Y., K.T., K.Y., H.O.)
| | - K Teranishi
- Departments of Neurosurgery (M.Y., K.T., K.Y., H.O.)
| | - K Yatomi
- Departments of Neurosurgery (M.Y., K.T., K.Y., H.O.)
| | - N Hamasaki
- Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - K K Kumamaru
- From the Department of Radiology (N.T., M.S., K.K.K., M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Hori
- From the Department of Radiology (N.T., M.S., K.K.K., M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - H Oishi
- Departments of Neurosurgery (M.Y., K.T., K.Y., H.O.).,Neuroendovascular Therapy (H.O.), Juntendo University School of Medicine, Tokyo, Japan
| | - S Aoki
- From the Department of Radiology (N.T., M.S., K.K.K., M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K.K.K., M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
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Kamagata K, Nakatsuka T, Sakakibara R, Tsuyusaki Y, Takamura T, Sato K, Suzuki M, Hori M, Kumamaru KK, Inaoka T, Aoki S, Terada H. Erratum to: Diagnostic imaging of dementia with Lewy bodies by susceptibility-weighted imaging of nigrosomes versus striatal dopamine transporter single-photon emission computed tomography: a retrospective observational study. Neuroradiology 2017; 59:425. [DOI: 10.1007/s00234-017-1814-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Takano N, Suzuki M, Irie R, Yamamoto M, Hamasaki N, Kamagata K, Kumamaru KK, Hori M, Oishi H, Aoki S. Usefulness of Non-Contrast-Enhanced MR Angiography Using a Silent Scan for Follow-Up after Y-Configuration Stent-Assisted Coil Embolization for Basilar Tip Aneurysms. AJNR Am J Neuroradiol 2016; 38:577-581. [PMID: 28007767 DOI: 10.3174/ajnr.a5033] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/12/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Y-configuration stent-assisted coil embolization is used for treating wide-neck aneurysms. Noninvasive alternatives to x-ray DSA for follow-up after Y-configuration stent-assisted coil embolization treatment are required. This study aimed to assess the usefulness of non-contrast-enhanced MRA by using a Silent Scan (silent MRA) for follow-up after Y-configuration stent-assisted coil embolization for basilar tip aneurysms. MATERIALS AND METHODS Seven patients treated with Y-configuration stent-assisted coil embolization for basilar tip aneurysms underwent silent MRA, 3D TOF-MRA, and DSA. Silent MRA and 3D TOF-MRA images were obtained during the same scan session on a 3T MR imaging system. Two neuroradiologists independently reviewed both types of MRA images and subjectively scored the flow in the stents on a scale of 1 (not visible) to 5 (nearly equal to DSA) by referring to the latest DSA image as a criterion standard. Furthermore, we evaluated the visualization of the neck remnant. RESULTS In all patients, the 2 observers gave a higher score for the flow in the stents on silent MRA than on 3D TOF-MRA. The average score ± standard deviation was 4.07 ± 0.70 for silent MRA and 1.93 ± 0.80 (P < .05) for 3D TOF-MRA. Neck remnants were depicted by DSA in 5 patients. In silent MRA, neck remnants were depicted in 5 patients, and visualization was similar to DSA; however, in 3D TOF-MRA, neck remnants were depicted in only 1 patient. CONCLUSIONS Silent MRA might be useful for follow-up after Y-configuration stent-assisted coil embolization.
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Affiliation(s)
- N Takano
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan .,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Suzuki
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - R Irie
- Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Yamamoto
- Departments of Neurosurgery (M.Y., H.O.)
| | - N Hamasaki
- Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - K Kamagata
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - K K Kumamaru
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - M Hori
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
| | - H Oishi
- Departments of Neurosurgery (M.Y., H.O.).,Neuroendovascular Therapy (H.O.), Juntendo University School of Medicine, Tokyo, Japan
| | - S Aoki
- From the Department of Radiology (N.T., M.S., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology (N.T., M.S., R.I., N.H., K. Kamagata, K.K. Kumamaru, M.H., S.A.), Juntendo University Hospital, Tokyo, Japan
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Andica C, Hagiwara A, Nakazawa M, Kumamaru KK, Hori M, Ikeno M, Shimizu T, Aoki S. Synthetic MR Imaging in the Diagnosis of Bacterial Meningitis. Magn Reson Med Sci 2016; 16:91-92. [PMID: 28003620 PMCID: PMC5600066 DOI: 10.2463/mrms.ci.2016-0082] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Hagiwara A, Hori M, Yokoyama K, Takemura MY, Andica C, Tabata T, Kamagata K, Suzuki M, Kumamaru KK, Nakazawa M, Takano N, Kawasaki H, Hamasaki N, Kunimatsu A, Aoki S. Synthetic MRI in the Detection of Multiple Sclerosis Plaques. AJNR Am J Neuroradiol 2016; 38:257-263. [PMID: 27932506 DOI: 10.3174/ajnr.a5012] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/20/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Synthetic MR imaging enables the creation of various contrast-weighted images including double inversion recovery and phase-sensitive inversion recovery from a single MR imaging quantification scan. Here, we assessed whether synthetic MR imaging is suitable for detecting MS plaques. MATERIALS AND METHODS Quantitative and conventional MR imaging data on 12 patients with MS were retrospectively analyzed. Synthetic T2-weighted, FLAIR, double inversion recovery, and phase-sensitive inversion recovery images were produced after quantification of T1 and T2 values and proton density. Double inversion recovery images were optimized for each patient by adjusting the TI. The number of visible plaques was determined by a radiologist for a set of these 4 types of synthetic MR images and a set of conventional T1-weighted inversion recovery, T2-weighted, and FLAIR images. Conventional 3D double inversion recovery and other available images were used as the criterion standard. The total acquisition time of synthetic MR imaging was 7 minutes 12 seconds and that of conventional MR imaging was 6 minutes 29 seconds The lesion-to-WM contrast and lesion-to-WM contrast-to-noise ratio were calculated and compared between synthetic and conventional double inversion recovery images. RESULTS The total plaques detected by synthetic and conventional MR images were 157 and 139, respectively (P = .014). The lesion-to-WM contrast and contrast-to-noise ratio on synthetic double inversion recovery images were superior to those on conventional double inversion recovery images (P = .001 and < 0.001, respectively). CONCLUSIONS Synthetic MR imaging enabled detection of more MS plaques than conventional MR imaging in a comparable acquisition time. The contrast for MS plaques on synthetic double inversion recovery images was better than on conventional double inversion recovery images.
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Affiliation(s)
- A Hagiwara
- From the Departments of Radiology (A.H., M.H., M.Y.T., C.A., T.T., K.K., M.S., K.K.K., M.N., N.T., H.K., N.H., S.A.) .,Department of Radiology (A.H., A.K.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - M Hori
- From the Departments of Radiology (A.H., M.H., M.Y.T., C.A., T.T., K.K., M.S., K.K.K., M.N., N.T., H.K., N.H., S.A.)
| | - K Yokoyama
- Neurology (K.Y.), Juntendo University School of Medicine, Tokyo, Japan
| | - M Y Takemura
- From the Departments of Radiology (A.H., M.H., M.Y.T., C.A., T.T., K.K., M.S., K.K.K., M.N., N.T., H.K., N.H., S.A.)
| | - C Andica
- From the Departments of Radiology (A.H., M.H., M.Y.T., C.A., T.T., K.K., M.S., K.K.K., M.N., N.T., H.K., N.H., S.A.)
| | - T Tabata
- From the Departments of Radiology (A.H., M.H., M.Y.T., C.A., T.T., K.K., M.S., K.K.K., M.N., N.T., H.K., N.H., S.A.)
| | - K Kamagata
- From the Departments of Radiology (A.H., M.H., M.Y.T., C.A., T.T., K.K., M.S., K.K.K., M.N., N.T., H.K., N.H., S.A.)
| | - M Suzuki
- From the Departments of Radiology (A.H., M.H., M.Y.T., C.A., T.T., K.K., M.S., K.K.K., M.N., N.T., H.K., N.H., S.A.)
| | - K K Kumamaru
- From the Departments of Radiology (A.H., M.H., M.Y.T., C.A., T.T., K.K., M.S., K.K.K., M.N., N.T., H.K., N.H., S.A.)
| | - M Nakazawa
- From the Departments of Radiology (A.H., M.H., M.Y.T., C.A., T.T., K.K., M.S., K.K.K., M.N., N.T., H.K., N.H., S.A.).,Department of Radiological Sciences (M.N.), Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - N Takano
- From the Departments of Radiology (A.H., M.H., M.Y.T., C.A., T.T., K.K., M.S., K.K.K., M.N., N.T., H.K., N.H., S.A.)
| | - H Kawasaki
- From the Departments of Radiology (A.H., M.H., M.Y.T., C.A., T.T., K.K., M.S., K.K.K., M.N., N.T., H.K., N.H., S.A.)
| | - N Hamasaki
- From the Departments of Radiology (A.H., M.H., M.Y.T., C.A., T.T., K.K., M.S., K.K.K., M.N., N.T., H.K., N.H., S.A.)
| | - A Kunimatsu
- Department of Radiology (A.H., A.K.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - S Aoki
- From the Departments of Radiology (A.H., M.H., M.Y.T., C.A., T.T., K.K., M.S., K.K.K., M.N., N.T., H.K., N.H., S.A.)
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Khandelwal A, Kondo T, Amanuma M, Oida A, Sano T, Sachin SS, Takase S, Rybicki FJ, Kumamaru KK. Single injection protocol for coronary and lower extremity CT angiographies in patients suspected for peripheral arterial disease. Medicine (Baltimore) 2016; 95:e5410. [PMID: 27861382 PMCID: PMC5120939 DOI: 10.1097/md.0000000000005410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
To evaluate the feasibility of a single injection protocol for coronary CT angiography (CTA) and lower extremity CTA in patients suspected for peripheral arterial disease (PAD).This prospective observational study included a total of 103 patients who showed an ankle brachial index ≤0.9 and underwent the single injection protocol for coronary and lower extremity CTA. All CTAs used iodinated contrast (weight × 0.06 mL/s × 20 seconds). A prospective Electrocardiogram (ECG)-gated coronary CTA was performed, followed by helical lower extremity CTA beginning 9 seconds after coronary CTA. Using catheter angiography as reference standard, diagnostic ability of CTA was evaluated.The mean total volume of iodinated contrast used was 70 ± 14 mL. Contrast opacification in the superficial femoral artery was adequate (408 ± 97 Hounsfield Units [HU]) and PAD was detected in 72.8% (75/103). The estimated radiation doses for lower extremity and coronary CTA were 3.6 ± 1.2 and 5.5 ± 4.5 mSv. A significant coronary stenosis was detected in 47 patients (45.6%). Coronary CT image quality was recorded as excellent in 86.4%, acceptable in 11.7%, and unacceptable for 1.9%. Contrast opacification within the superficial femoral artery was adequate in all cases while 27.2% needed an additional scan below the calf to capture the contrast bolus arrival in the smaller lower extremity vessels. Segment based sensitivity, specificity, positive, and negative predictive values were 57.9%, 97.9%, 73.8%, and 95.9% for the coronary CTA, and 63.4%, 91.5%, 76.3%, and 85.3% for peripheral CTA.A single injection protocol for coronary CTA and lower extremity CTA is feasible with a relatively small volume of iodinated contrast.
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Affiliation(s)
- Ashish Khandelwal
- Department of Radiology, Applied Imaging Science Laboratory, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Saboo S. Sachin
- Department of Radiology, Applied Imaging Science Laboratory, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | | | - Frank J. Rybicki
- Department of Radiology, Applied Imaging Science Laboratory, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts
- Department of Radiology, The Ottawa Hospital and Ottawa University, Ottawa, Ontario, Canada
| | - Kanako K. Kumamaru
- Department of Radiology, Applied Imaging Science Laboratory, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Juntendo University, Tokyo, Japan
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Hagiwara A, Hori M, Yokoyama K, Takemura MY, Andica C, Kumamaru KK, Nakazawa M, Takano N, Kawasaki H, Sato S, Hamasaki N, Kunimatsu A, Aoki S. Utility of a Multiparametric Quantitative MRI Model That Assesses Myelin and Edema for Evaluating Plaques, Periplaque White Matter, and Normal-Appearing White Matter in Patients with Multiple Sclerosis: A Feasibility Study. AJNR Am J Neuroradiol 2016; 38:237-242. [PMID: 27789453 DOI: 10.3174/ajnr.a4977] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/29/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE T1 and T2 values and proton density can now be quantified on the basis of a single MR acquisition. The myelin and edema in a voxel can also be estimated from these values. The purpose of this study was to evaluate a multiparametric quantitative MR imaging model that assesses myelin and edema for characterizing plaques, periplaque white matter, and normal-appearing white matter in patients with MS. MATERIALS AND METHODS We examined 3T quantitative MR imaging data from 21 patients with MS. The myelin partial volume, excess parenchymal water partial volume, the inverse of T1 and transverse T2 relaxation times (R1, R2), and proton density were compared among plaques, periplaque white matter, and normal-appearing white matter. RESULTS All metrics differed significantly across the 3 groups (P < .001). Those in plaques differed most from those in normal-appearing white matter. The percentage changes of the metrics in plaques and periplaque white matter relative to normal-appearing white matter were significantly more different from zero for myelin partial volume (mean, -61.59 ± 20.28% [plaque relative to normal-appearing white matter], and mean, -10.51 ± 11.41% [periplaque white matter relative to normal-appearing white matter]), and excess parenchymal water partial volume (13.82 × 103 ± 49.47 × 103% and 51.33 × 102 ± 155.31 × 102%) than for R1 (-35.23 ± 13.93% and -6.08 ± 8.66%), R2 (-21.06 ± 11.39% and -4.79 ± 6.79%), and proton density (23.37 ± 10.30% and 3.37 ± 4.24%). CONCLUSIONS Multiparametric quantitative MR imaging captures white matter damage in MS. Myelin partial volume and excess parenchymal water partial volume are more sensitive to the MS disease process than R1, R2, and proton density.
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Affiliation(s)
- A Hagiwara
- From the Department of Radiology (A.H., A.K.), Graduate School of Medicine, University of Tokyo, Tokyo, Japan .,Departments of Radiology (A.H., M.H., M.Y.T., C.A., K.K.K., M.N., N.T., H.K., S.S., N.H., S.A.)
| | - M Hori
- Departments of Radiology (A.H., M.H., M.Y.T., C.A., K.K.K., M.N., N.T., H.K., S.S., N.H., S.A.)
| | - K Yokoyama
- Neurology (K.Y.), Juntendo University School of Medicine, Tokyo, Japan
| | - M Y Takemura
- Departments of Radiology (A.H., M.H., M.Y.T., C.A., K.K.K., M.N., N.T., H.K., S.S., N.H., S.A.)
| | - C Andica
- Departments of Radiology (A.H., M.H., M.Y.T., C.A., K.K.K., M.N., N.T., H.K., S.S., N.H., S.A.)
| | - K K Kumamaru
- Departments of Radiology (A.H., M.H., M.Y.T., C.A., K.K.K., M.N., N.T., H.K., S.S., N.H., S.A.)
| | - M Nakazawa
- Departments of Radiology (A.H., M.H., M.Y.T., C.A., K.K.K., M.N., N.T., H.K., S.S., N.H., S.A.)
| | - N Takano
- Departments of Radiology (A.H., M.H., M.Y.T., C.A., K.K.K., M.N., N.T., H.K., S.S., N.H., S.A.)
| | - H Kawasaki
- Departments of Radiology (A.H., M.H., M.Y.T., C.A., K.K.K., M.N., N.T., H.K., S.S., N.H., S.A.)
| | - S Sato
- Departments of Radiology (A.H., M.H., M.Y.T., C.A., K.K.K., M.N., N.T., H.K., S.S., N.H., S.A.)
| | - N Hamasaki
- Departments of Radiology (A.H., M.H., M.Y.T., C.A., K.K.K., M.N., N.T., H.K., S.S., N.H., S.A.)
| | - A Kunimatsu
- From the Department of Radiology (A.H., A.K.), Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - S Aoki
- Departments of Radiology (A.H., M.H., M.Y.T., C.A., K.K.K., M.N., N.T., H.K., S.S., N.H., S.A.)
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Cai T, Giannopoulos AA, Yu S, Kelil T, Ripley B, Kumamaru KK, Rybicki FJ, Mitsouras D. Natural Language Processing Technologies in Radiology Research and Clinical Applications. Radiographics 2016; 36:176-91. [PMID: 26761536 DOI: 10.1148/rg.2016150080] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The migration of imaging reports to electronic medical record systems holds great potential in terms of advancing radiology research and practice by leveraging the large volume of data continuously being updated, integrated, and shared. However, there are significant challenges as well, largely due to the heterogeneity of how these data are formatted. Indeed, although there is movement toward structured reporting in radiology (ie, hierarchically itemized reporting with use of standardized terminology), the majority of radiology reports remain unstructured and use free-form language. To effectively "mine" these large datasets for hypothesis testing, a robust strategy for extracting the necessary information is needed. Manual extraction of information is a time-consuming and often unmanageable task. "Intelligent" search engines that instead rely on natural language processing (NLP), a computer-based approach to analyzing free-form text or speech, can be used to automate this data mining task. The overall goal of NLP is to translate natural human language into a structured format (ie, a fixed collection of elements), each with a standardized set of choices for its value, that is easily manipulated by computer programs to (among other things) order into subcategories or query for the presence or absence of a finding. The authors review the fundamentals of NLP and describe various techniques that constitute NLP in radiology, along with some key applications.
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Affiliation(s)
- Tianrun Cai
- From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (T.C., A.A.G., K.K.K., F.J.R., D.M.); Harvard T.H. Chan School of Public Health, Boston, Mass (S.Y.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (T.K., B.R.)
| | - Andreas A Giannopoulos
- From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (T.C., A.A.G., K.K.K., F.J.R., D.M.); Harvard T.H. Chan School of Public Health, Boston, Mass (S.Y.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (T.K., B.R.)
| | - Sheng Yu
- From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (T.C., A.A.G., K.K.K., F.J.R., D.M.); Harvard T.H. Chan School of Public Health, Boston, Mass (S.Y.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (T.K., B.R.)
| | - Tatiana Kelil
- From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (T.C., A.A.G., K.K.K., F.J.R., D.M.); Harvard T.H. Chan School of Public Health, Boston, Mass (S.Y.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (T.K., B.R.)
| | - Beth Ripley
- From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (T.C., A.A.G., K.K.K., F.J.R., D.M.); Harvard T.H. Chan School of Public Health, Boston, Mass (S.Y.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (T.K., B.R.)
| | - Kanako K Kumamaru
- From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (T.C., A.A.G., K.K.K., F.J.R., D.M.); Harvard T.H. Chan School of Public Health, Boston, Mass (S.Y.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (T.K., B.R.)
| | - Frank J Rybicki
- From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (T.C., A.A.G., K.K.K., F.J.R., D.M.); Harvard T.H. Chan School of Public Health, Boston, Mass (S.Y.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (T.K., B.R.)
| | - Dimitrios Mitsouras
- From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (T.C., A.A.G., K.K.K., F.J.R., D.M.); Harvard T.H. Chan School of Public Health, Boston, Mass (S.Y.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (T.K., B.R.)
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Mitsouras D, Liacouras P, Imanzadeh A, Giannopoulos AA, Cai T, Kumamaru KK, George E, Wake N, Caterson EJ, Pomahac B, Ho VB, Grant GT, Rybicki FJ. Medical 3D Printing for the Radiologist. Radiographics 2016; 35:1965-88. [PMID: 26562233 DOI: 10.1148/rg.2015140320] [Citation(s) in RCA: 354] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
While use of advanced visualization in radiology is instrumental in diagnosis and communication with referring clinicians, there is an unmet need to render Digital Imaging and Communications in Medicine (DICOM) images as three-dimensional (3D) printed models capable of providing both tactile feedback and tangible depth information about anatomic and pathologic states. Three-dimensional printed models, already entrenched in the nonmedical sciences, are rapidly being embraced in medicine as well as in the lay community. Incorporating 3D printing from images generated and interpreted by radiologists presents particular challenges, including training, materials and equipment, and guidelines. The overall costs of a 3D printing laboratory must be balanced by the clinical benefits. It is expected that the number of 3D-printed models generated from DICOM images for planning interventions and fabricating implants will grow exponentially. Radiologists should at a minimum be familiar with 3D printing as it relates to their field, including types of 3D printing technologies and materials used to create 3D-printed anatomic models, published applications of models to date, and clinical benefits in radiology. Online supplemental material is available for this article.
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Affiliation(s)
- Dimitris Mitsouras
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Peter Liacouras
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Amir Imanzadeh
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Andreas A Giannopoulos
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Tianrun Cai
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Kanako K Kumamaru
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Elizabeth George
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Nicole Wake
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Edward J Caterson
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Bohdan Pomahac
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Vincent B Ho
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Gerald T Grant
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Frank J Rybicki
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
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Kumamaru KK, Saboo SS, Aghayev A, Cai P, Quesada CG, George E, Hussain Z, Cai T, Rybicki FJ. CT pulmonary angiography-based scoring system to predict the prognosis of acute pulmonary embolism. J Cardiovasc Comput Tomogr 2016; 10:473-479. [PMID: 27591768 DOI: 10.1016/j.jcct.2016.08.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/07/2016] [Accepted: 08/20/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose is to develop a comprehensive risk-scoring system based on CT findings for predicting 30-day mortality after acute pulmonary embolism (PE), and to compare it with PE Severity Index (PESI). MATERIALS AND METHODS The study included consecutive 1698 CT pulmonary angiograms (CTPA) positive for acute PE performed at a single institution (2003-2010). Two radiologists independently assessed each study regarding clinically relevant findings and then performed adjudication. These variables plus patient clinical information were included to build a LASSO logistic regression model to predict 30-day mortality. A point score for each significant variable was generated based on the final model. PESI score was calculated in 568 patients who visited the hospital after 2007. RESULTS Inter-reader agreements of interpretations were >95% except for septal bowing (92%). The final prediction model showed superior ability over PESI (AUC = 0.822 vs 0.745) for predicting all-cause 30-day mortality (12.4%). The scoring system based on the significant variables (age (years), pleural effusion (+20), pericardial effusion (+20), lung/liver/bone lesions suggesting malignancy (+60), chronic interstitial lung disease (+20), enlarged lymph node in thorax (+20), and ascites (+40)) stratified patients into 4 severity categories, with mortality rates of 0.008% in class-I (≤50 pt), 3.8% in class-II (51-100 pt), 17.6% in class-III (101-150 pt), and 40.9% in class-IV (>150 pt). The mortality rate in the CTPA-high risk category (class-IV) was higher than those in the PESI's high risk (27.4%) and very high risk (25.2%) categories. CONCLUSION The CTPA-based model was superior to PESI in predicting 30-day mortality. Incorporating the CTPA-based scoring system into image interpretation workflows may help physicians to select the most appropriate management approach for individual patients.
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Affiliation(s)
- Kanako K Kumamaru
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States; Department of Radiology, Juntendo Univeristy, Tokyo, Japan.
| | - Sachin S Saboo
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States; Department of Radiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Ayaz Aghayev
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States
| | - Phoebe Cai
- Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Carlos Gonzalez Quesada
- Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States
| | - Elizabeth George
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States
| | - Zoha Hussain
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States
| | - Tianrun Cai
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States
| | - Frank J Rybicki
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States; Department of Radiology, The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Kumamaru KK, Kumamaru H, Bateman BT, Gronsbell J, Cai T, Liu J, Higgins LD, Aoki S, Ohtomo K, Rybicki FJ, Patorno E. Limited Hospital Variation in the Use and Yield of CT for Pulmonary Embolism in Patients Undergoing Total Hip or Total Knee Replacement Surgery. Radiology 2016; 281:826-834. [PMID: 27228331 DOI: 10.1148/radiol.2016152765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the variation among U.S. hospitals in overall use and yield of in-hospital computed tomographic (CT) pulmonary angiography (PA) in patients undergoing total hip replacement (THR) or total knee replacement (TKR) surgery. Materials and Methods Patients in the Premier Research Database who underwent elective TKR or THR between 2007 and 2011 were enrolled in this HIPAA-compliant, institutional review board-approved retrospective observational study. The informed consent requirement was waived. Hospitals were categorized into low, medium, and high tertiles of CT PA use to compare baseline patient- and hospital-level characteristics and pulmonary embolism (PE) positivity rates. To further investigate between-hospital variation in CT PA use, a hierarchical logistic regression model that included hospital-specific random effects and fixed patient- and hospital-level effects was used. The intraclass correlation coefficient (ICC) was used to measure the amount of variability in CT PA use attributable to between-hospital variation. Results The cohort included 205 198 patients discharged from 178 hospitals (median of 734.5 patients discharged per hospital; interquartile range, 316-1461 patients) with 3647 CT PA studies (1.8%). The crude frequency of CT PA scans among the hospitals ranged from 0% to 6.2% (median, 1.6%); more than 90% of the hospitals performed CT PA in less than 3% of their patients. The mean hospital-level PE positivity rate was 12.3% (median, 9.1%); there was no significant difference in PE positivity rate across low through high CT PA use tertiles (11.3%, 11.9%, 12.9%, P = .37). After adjustment for hospital- and patient-level factors, the remaining amount of interhospital variation was relatively low (ICC, 9.0%). Conclusion Limited interhospital variation in use and yield of in-hospital CT PA was observed among patients undergoing TKR or THR in the United States. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Kanako K Kumamaru
- From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.)
| | - Hiraku Kumamaru
- From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.)
| | - Brian T Bateman
- From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.)
| | - Jessica Gronsbell
- From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.)
| | - Tianxi Cai
- From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.)
| | - Jun Liu
- From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.)
| | - Laurence D Higgins
- From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.)
| | - Shigeki Aoki
- From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.)
| | - Kuni Ohtomo
- From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.)
| | - Frank J Rybicki
- From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.)
| | - Elisabetta Patorno
- From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.)
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Kumamaru KK, George E, Ghosh N, Quesada CG, Wake N, Gerhard-Herman M, Rybicki FJ. Normal ventricular diameter ratio on CT provides adequate assessment for critical right ventricular strain among patients with acute pulmonary embolism. Int J Cardiovasc Imaging 2016; 32:1153-61. [PMID: 27076224 DOI: 10.1007/s10554-016-0887-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/29/2016] [Indexed: 01/21/2023]
Abstract
There is variability in guideline recommendations for assessment of the right ventricle (RV) with imaging as prognostic information after acute pulmonary embolism (PE). The objective of this study is to identify a clinical scenario for which normal CT-derived right-to-left ventricular (RV/LV) ratio is sufficient to exclude RV strain or PE-related short-term death. This retrospective cohort study included 579 consecutive subjects (08/2003-03/2010) diagnosed with acute PE with normal CT-RV/LV ratio (<0.9), 236 of whom received subsequent echocardiography. To identify a clinical scenario for which CT-RV/LV ratio was considered sufficient to exclude RV strain or PE-related short-term death, a multivariable logistic model was created to detect factors related to subjects for whom subsequent echocardiography detected RV strain or those who did not receive echocardiography and died of PE within 14 days (n = 55). The final model included five variables (c-statistic = 0.758, over-fitting bias = 2.52 %): congestive heart failure (adjusted odds ratio, OR 4.32, 95 % confidence interval, CI 1.88-9.92), RV diameter on CT >45 mm (OR 3.07, 95 % CI 1.56-6.03), age >60 years (OR 2.59, 95 % CI 1.41-4.77), central embolus (OR 1.96, 95 % CI 1.01-3.79), and stage-IV cancer (OR 1.94, 95 % CI 0.99-3.78). If these five factors were all absent (37.1 % of the population), the probability that "CT-RV/LV ratio is sufficient to exclude RV strain/PE-related short-term death" was 0.97 (95 % CI = 0.95-0.99). Normal CT-RV/LV ratio plus readily obtained five clinical predictors were adequate to exclude RV strain or PE-related short-term mortality.
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Affiliation(s)
- Kanako K Kumamaru
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Radiology, Juntendo Univeristy, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Elizabeth George
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nina Ghosh
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carlos Gonzalez Quesada
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicole Wake
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,The Sackler Institute of Graduate Biomedical Sciences, New York University, New York, NY, USA
| | - Marie Gerhard-Herman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frank J Rybicki
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,The Department of Radiology, The Ottawa Hospital Research Institute, The University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
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Tai R, Dunne RM, Trotman-Dickenson B, Jacobson FL, Madan R, Kumamaru KK, Hunsaker AR. Frequency and Severity of Pulmonary Hemorrhage in Patients Undergoing Percutaneous CT-guided Transthoracic Lung Biopsy: Single-Institution Experience of 1175 Cases. Radiology 2016; 279:287-96. [DOI: 10.1148/radiol.2015150381] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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46
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Kueckelhaus M, Turk M, Kumamaru KK, Wo L, Bueno EM, Lian CG, Alhefzi M, Aycart MA, Fischer S, De Girolami U, Murphy GF, Rybicki FJ, Pomahac B. Transformation of Face Transplants: Volumetric and Morphologic Graft Changes Resemble Aging After Facial Allotransplantation. Am J Transplant 2016; 16:968-78. [PMID: 26639618 DOI: 10.1111/ajt.13544] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/03/2015] [Accepted: 09/18/2015] [Indexed: 01/25/2023]
Abstract
Facial allotransplantation restores normal anatomy to severely disfigured faces. Although >30 such operations performed worldwide have yielded promising short-term results, data on long-term outcomes remain scarce. Three full-face transplant recipients were followed for 40 months. Severe changes in volume and composition of the facial allografts were noted. Data from computed tomography performed 6, 18 and 36 months after transplantation were processed to separate allograft from recipient tissues and further into bone, fat and nonfat soft tissues. Skin and muscle biopsies underwent diagnostic evaluation. All three facial allografts sustained significant volume loss (mean 19.55%) between 6 and 36 months after transplant. Bone and nonfat soft tissue volumes decreased significantly over time (17.22% between months 6 and 18 and 25.56% between months 6 and 36, respectively), whereas fat did not. Histological evaluations showed atrophy of muscle fibers. Volumetric and morphometric changes in facial allografts have not been reported previously. The transformation of facial allografts in this study resembled aging through volume loss but differed substantially from regular aging. These findings have implications for risk-benefit assessment, donor selection and measures counteracting muscle and bone atrophy. Superior long-term outcomes of facial allotransplantation will be crucial to advance toward future clinical routine.
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Affiliation(s)
- M Kueckelhaus
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - M Turk
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - K K Kumamaru
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - L Wo
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - E M Bueno
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - C G Lian
- Division of Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - M Alhefzi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - M A Aycart
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - S Fischer
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Plastic Surgery, BG University Hospital Ludwigshafen, Heidelberg University, Ludwigshafen, Germany
| | - U De Girolami
- Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - G F Murphy
- Division of Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - F J Rybicki
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - B Pomahac
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Demehri S, Signorelli J, Kumamaru KK, Wake N, George E, Hanley M, Steigner ML, Gravereaux EC, Rybicki FJ. Volumetric Quantification of Type II Endoleaks: An Indicator for Aneurysm Sac Growth Following Endovascular Abdominal Aortic Aneurysm Repair. Radiology 2015; 277:308. [PMID: 26402504 DOI: 10.1148/radiol.2015154029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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George E, Giannopoulos AA, Aghayev A, Rohatgi S, Imanzadeh A, Antoniadis AP, Kumamaru KK, Chatzizisis YS, Dunne R, Steigner M, Hanley M, Gravereaux EC, Rybicki FJ, Mitsouras D. Contrast inhomogeneity in CT angiography of the abdominal aortic aneurysm. J Cardiovasc Comput Tomogr 2015; 10:179-83. [PMID: 26714669 DOI: 10.1016/j.jcct.2015.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 11/20/2015] [Accepted: 11/26/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND If undetected, infrarenal Abdominal Aortic Aneurysm (AAA) growth can lead to rupture, a high-mortality complication. Some AAA patients exhibit inhomogeneous luminal contrast attenuation at first-pass CT angiography (CTA). This study assesses the association between this observation and aneurysm growth. METHODS Sixty-seven consecutive pre-repair AAA CTAs were included in this retrospective study. The "Gravitational Gradient" (GG), defined as the ratio of the mean attenuation in a region-of-interest placed posteriorly to that in a region-of-interest placed anteriorly within the lumen of the aortic aneurysm on a single axial slice, and the maximum aneurysm diameter were measured from each CT data set. "AAA Contrast Inhomogeneity" was defined as the absolute value of the difference between the GG and 1.0. Univariate and multivariate logistic regression was used to assess the association of aneurysm growth >0.4 and >1.0 cm/year to AAA Contrast Inhomogeneity, aneurysm diameter, patient characteristics and cardiovascular co-morbidities. RESULTS AAA Contrast Inhomogeneity was not correlated to aneurysm diameter (p = 0.325). In multivariable analysis that included initial aneurysm diameter and AAA Contrast Inhomogeneity, both factors were significantly associated with rapid aneurysm growth (initial diameter: p = 0.029 and 0.011, and, AAA Contrast Inhomogeneity: p = 0.045 and 0.048 for growth >0.4 cm/year and >1 cm/year respectively). CONCLUSIONS AAA Contrast Inhomogeneity is a common observation in first-pass CTA. It is associated with rapid aneurysm growth, independent of aneurysm diameter.
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Affiliation(s)
- Elizabeth George
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Andreas A Giannopoulos
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ayaz Aghayev
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Saurabh Rohatgi
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Amir Imanzadeh
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | - Ruth Dunne
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael Steigner
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael Hanley
- Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Edwin C Gravereaux
- Division of Vascular Surgery, Brigham & Women's Hospital, Boston, MA, USA
| | - Frank J Rybicki
- The Ottawa Hospital Research Institute and Department of Radiology, The University of Ottawa, Ontario, ON, Canada
| | - Dimitrios Mitsouras
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
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Cai T, Rybicki FJ, Giannopoulos AA, Schultz K, Kumamaru KK, Liacouras P, Demehri S, Shu Small KM, Mitsouras D. The residual STL volume as a metric to evaluate accuracy and reproducibility of anatomic models for 3D printing: application in the validation of 3D-printable models of maxillofacial bone from reduced radiation dose CT images. 3D Print Med 2015; 1:2. [PMID: 30050971 PMCID: PMC6036610 DOI: 10.1186/s41205-015-0003-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 09/29/2015] [Indexed: 11/18/2022] Open
Abstract
Background The effects of reduced radiation dose CT for the generation of maxillofacial bone STL models for 3D printing is currently unknown. Images of two full-face transplantation patients scanned with non-contrast 320-detector row CT were reconstructed at fractions of the acquisition radiation dose using noise simulation software and both filtered back-projection (FBP) and Adaptive Iterative Dose Reduction 3D (AIDR3D). The maxillofacial bone STL model segmented with thresholding from AIDR3D images at 100 % dose was considered the reference. For all other dose/reconstruction method combinations, a “residual STL volume” was calculated as the topologic subtraction of the STL model derived from that dataset from the reference and correlated to radiation dose. Results The residual volume decreased with increasing radiation dose and was lower for AIDR3D compared to FBP reconstructions at all doses. As a fraction of the reference STL volume, the residual volume decreased from 2.9 % (20 % dose) to 1.4 % (50 % dose) in patient 1, and from 4.1 % to 1.9 %, respectively in patient 2 for AIDR3D reconstructions. For FBP reconstructions it decreased from 3.3 % (20 % dose) to 1.0 % (100 % dose) in patient 1, and from 5.5 % to 1.6 %, respectively in patient 2. Its morphology resembled a thin shell on the osseous surface with average thickness <0.1 mm. Conclusion The residual volume, a topological difference metric of STL models of tissue depicted in DICOM images supports that reduction of CT dose by up to 80 % of the clinical acquisition in conjunction with iterative reconstruction yields maxillofacial bone models accurate for 3D printing.
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Affiliation(s)
- Tianrun Cai
- Applied Imaging Science Lab, Department of Radiology, Brigham and Women's Hospital, Boston, MA USA
| | - Frank J Rybicki
- The Ottawa Hospital Research Institute and Medical Imaging, Ottawa, ON Canada.,Department of Radiology, University of Ottawa, Ottawa, ON Canada
| | - Andreas A Giannopoulos
- Applied Imaging Science Lab, Department of Radiology, Brigham and Women's Hospital, Boston, MA USA
| | - Kurt Schultz
- Toshiba Medical Research Institute USA, Vernon Hills, IL USA
| | | | - Peter Liacouras
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD USA
| | - Shadpour Demehri
- Division of Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD USA
| | | | - Dimitris Mitsouras
- Department of Radiology, Brigham and Women's Hospital, Boston, MA USA.,Applied Imaging Science Lab, Department of Radiology, Brigham and Women's Hospital, Boston, MA USA
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50
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Kamagata K, Hatano T, Okuzumi A, Motoi Y, Abe O, Shimoji K, Kamiya K, Suzuki M, Hori M, Kumamaru KK, Hattori N, Aoki S. Neurite orientation dispersion and density imaging in the substantia nigra in idiopathic Parkinson disease. Eur Radiol 2015; 26:2567-77. [PMID: 26515546 DOI: 10.1007/s00330-015-4066-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 10/02/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We used neurite orientation dispersion and density imaging (NODDI) to quantify changes in the substantia nigra pars compacta (SNpc) and striatum in Parkinson disease (PD). METHODS Diffusion-weighted magnetic resonance images were acquired from 58 PD patients and 36 age- and sex-matched controls. The intracellular volume fraction (Vic), orientation dispersion index (OD), and isotropic volume fraction (Viso) of the basal ganglia were compared between groups. Multivariate logistic regression analysis determined which diffusion parameters were independent predictors of PD. Receiver operating characteristic (ROC) analysis compared the diagnostic accuracies of the evaluated indices. Pearson coefficient analysis correlated each diffusional parameter with disease severity. RESULTS Vic in the contralateral SNpc and putamen were significantly lower in PD patients than in healthy controls (P < 0.00058). Vic and OD in the SNpc and putamen showed significant negative correlations (P < 0.05) with disease severity. Multivariate logistic analysis revealed that Vic (P = 0.0000046) and mean diffusivity (P = 0.019) in the contralateral SNpc were the independent predictors of PD. In the ROC analysis, Vic in the contralateral SNpc showed the best diagnostic performance (mean cutoff, 0.62; sensitivity, 0.88; specificity, 0.83). CONCLUSION NODDI is likely to be useful for diagnosing PD and assessing its progression. KEY POINTS • Neurite orientation dispersion and density imaging (NODDI) is a new diffusion MRI technique • NODDI estimates neurite microstructure more specifically than diffusion tensor imaging • By using NODDI, nigrostriatal alterations in PD can be evaluated in vivo • NOODI is useful for diagnosing PD and assessing its disease progression.
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Affiliation(s)
- Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Taku Hatano
- Department of Neurology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ayami Okuzumi
- Department of Neurology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yumiko Motoi
- Department of Neurology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Osamu Abe
- Department of Radiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Keigo Shimoji
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Kouhei Kamiya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Michimasa Suzuki
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masaaki Hori
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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