Noriyuki Yanagawa

Quality of coronary arterial 320-slice computed tomography images in subjects with chronic atrial fibrillation compared with normal sinus rhythm

PURPOSE To evaluate coronary arterial image quality on 320-slice CT in subjects with chronic atrial fibrillation (CAf) vs. normal sinus rhythm (NSR). MATERIALS AND METHODS In 92 consecutive subjects, 46 each with CAf (male:female ratio 2.54:1.00, age 69.7 ± 9.9 years) and NSR (male:female ratio 1.88:1.00, age 63.7 ± 13.7 years), 320-slice CT (Aquilion-one) was performed with enhanced images reconstructed at 80% of ECG R-to-R intervals. Visualized coronary vessels >1.5mm diameter in the right coronary artery, left anterior descending (LAD), and circumflex (LCx) distribution were evaluated for length, percentage of length free from motion artifacts, and image quality on a scale ranging from 1 (highest quality) to 5 (lowest quality). RESULTS LCx length measurements were significantly greater in subjects with NSR (108.8 ± 27.0mm) than CAf (96.6 ± 31.4mm) (P = 0.049), whereas percentages of length free from motion artifacts did not differ between the three vascular beds. Image quality, was significantly but marginally better overall in NSR than in CAF, as well as for LAD and LCx vascular beds. Mean scores in subjects with CAf and NSR were 1.4 ± 0.7 and 1.3 ± 0.6 in all arteries, 1.4 ± 0.7 and 1.2 ± 0.5 in LAD, and 1.5 ± 0.7 and 1.2 ± 0.5 in LCx, respectively (all P<0.001). Despite this difference in image quality, mean scores for both CAf and NSR were weighted toward the high quality end of the scale. CONCLUSION By 320-slice CT, the overall length of visualized coronary arteries, motion artifact-free length, and image quality using a 5-point scale showed values equal to or slightly lower in CAf than in NSR, but the absolute values were quite acceptable in both groups.

Quantitative Measurement of Blood Flow Using Perfusion CT for Assessing Clinicopathologic Features and Prognosis in Patients with Rectal Cancer

PURPOSE: The ability to evaluate clinicopathologic features and prognosis before surgery by contrast-enhanced CT would be valuable for managing rectal cancer. This study was designed to evaluate the clinical usefulness of perfusion CT in patients with rectal cancer before surgery. METHODS: Forty-four consecutive patients (27 men, 17 women; median age, 63.6 years) with rectal cancer underwent perfusion CT before surgery. We retrospectively investigated the correlations between tumor blood flow generated by perfusion CT and clinicopathologic features. RESULTS: There was a significant correlation between blood flow and wall invasion (P = 0.04). Well-differentiated tumors showed significantly higher blood flow than moderately differentiated tumors (P = 0.03). There was a significant tendency for tumors with low blood flow to show lymph node metastasis (P = 0.0005), vascular invasion (P = 0.004), lymphatic invasion (P = 0.04), and distant metastasis (P = 0.0005). For blood flow, accuracy was 75% for detection of tumors with lymph node metastasis if the cutoff point was set at 55 ml/100 g per minute. Patients with high blood flow tumors survived significantly longer than those with low blood flow tumors (P = 0.002). CONCLUSIONS: Blood flow of rectal cancers may be useful to evaluate pathologic features and prognosis before surgery.

Efficacy and reliability of highly functional open source DICOM software (OsiriX) in spine surgery

We evaluated the feasibility and reliability of open source Digital Imaging and COmmunication in Medicine (DICOM) imaging software, OsiriX (Antoine Rosset, 2003-2009), in spine surgery. CT data were used and processed with OsiriX and with commercial software for comparison. Images were reconstructed and compared in volume rendering (VR) and multi-planar reconstruction (MPR) mode. When all images were compared, the three-dimensional (3D) reconstructed images from both software packages showed considerable consistency in VR mode. Measurements in MPR mode also showed similar values with no statistically significant difference. These results demonstrate that OsiriX has approximately equivalent values to commercial software and provides reliable preoperative 3D information for the surgical field. In addition, any clinician, can obtain information using OsiriX at any time. Thus, OsiriX is a helpful tool in preoperative planning for spine surgery.

Role of 320-Slice CT Imaging in the Diagnostic Workup of Patients With Chronic Thromboembolic Pulmonary Hypertension

BACKGROUND Right-sided heart catheterization (RHC) and pulmonary digital subtraction angiography (PDSA) are the standard methods used in diagnosing suspected or defi nite chronic thromboembolic pulmonary hypertension (CTEPH). We studied the ability of 320-slice CT imaging to detect simultaneously chronic thromboembolic fi ndings in the pulmonary arteries and pulmonary hemodynamics based on the curvature of the interventricular septum (IVS) in CTEPH . METHODS Forty-four patients with high clinical suspicion of CTEPH underwent RHC, PDSA, and enhanced double-volume retrospective ECG-gated 320-slice CT scan. We measured the sensitivity and specificity of CT imaging to detect thrombi in the pulmonary arteries compared with PDSA. We also compared IVS bowing (expressed as curvature) measured on the short-axis cine heart image with pulmonary arterial pressure (PAP) obtained by RHC. RESULTS Compared with PDSA, the sensitivity and specificity of CT imaging to detect chronic thromboembolic findings were 97.0% and 97.1% at the main/lobar level and 85.8% and 94.6% at the segmental level, respectively. The correlation coefficients of IVS curvature with systolic PAP and mean PAP were 2 0.79 ( P , .001) and 2 0.86 ( P , .001), respectively. CONCLUSIONS The use of 320-slice CT imaging allows for less invasive and simultaneous detection of thrombi and evaluation of pulmonary hemodynamics for the diagnostic work-up of CTEPH.

Role of Perfusion CT in Assessing Tumor Blood Flow and Malignancy Level of Gastric Cancer

Background/Aims: Intratumoral hemodynamics or tumor perfusion is useful in understanding the pathological background of the cancer. A parameter for a non-invasive, preoperative assessment of tumor perfusion has yet to be developed. Methods: The study included 50 patients who underwent surgery for gastric cancer. Perfusion computed tomography (P-CT) was performed using a 16-row multidetector CT, and tumor blood flow (ml/min/100 g tissue) values were measured. We compared blood flow with histopathological characteristics and evaluated its correlation with microvessel density and tumor stromal density and calculated the ratio of vessels and stromal tissue. Results: There was a significant decrease in blood flow in advanced tumor depth, peritoneal dissemination and undifferentiated subtypes. Cases with Lauren’s diffuse type carcinoma were found to have decreased blood flow compared to the mixed or intestinal type. As for the stromal structure, despite the lack of correlation with microvessel density, blood flow significantly decreased with increased stromal density. Conclusions: Decreased blood flow value acquired from P-CT may reflect a progressive state of gastric cancer. The pathological background for this relation involves the tumor stroma. Tumor perfusion decreased as the stage and malignant character of the tumor advanced, and therefore P-CT could be a better strategy to estimate the malignancy level of cancer.

Utility of three-dimensional global longitudinal strain of the right ventricle using transthoracic echocardiography for right ventricular systolic function in pulmonary hypertension

ventricle using transthoracic echocardiography for right ventricular systolic function in pulmonary hypertension Koya Ozawa , Nobusada Funabashi ⁎, Hiroyuki Takaoka , Nobuhiro Tanabe , Noriyuki Yanagawa , Koichiro Tatsumi , Yoshio Kobayashi a a Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan b Department of Respirology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan

Chronic obstructive pulmonary disease and interstitial lung disease in patients with lung cancer

Background and objective:  Although lung cancer is frequently accompanied by COPD and interstitial lung disease (ILD), the precise coincidence of these diseases with lung cancer is not well understood. The objectives of this study were to determine the prevalence of abnormal CT and spirometric findings suggestive of COPD or ILD in a population of patients with untreated lung cancer, and to estimate the lung cancer risk in this population.

Quantitative assessment of cross-sectional area of small pulmonary vessels in patients with COPD using inspiratory and expiratory MDCT

OBJECTIVES Structural and functional changes in pulmonary vessels are prevalent at the initial stages of chronic obstructive pulmonary disease (COPD). These vascular alterations can be assessed using cross-sectional area (CSA) of small pulmonary vessels. However, neither in non-COPD smokers nor in COPD patients it has been defined whether the structural changes of pulmonary vessels detected by paired inspiratory and expiratory CT scans are associated with emphysematous changes. We quantified the CSA and low attenuation area (LAA) and evaluated the changes in these parameters in the inspiratory and expiratory phases. MATERIALS AND METHODS Fifty consecutive non-COPD smokers and COPD patients were subjected to multi detector-row CT and the percentage of vessels with a CSA less than 5 mm(2) as well as the percentage LAA for total lung area (%CSA<5, %LAA, respectively) were calculated. RESULTS The %CSA<5 correlated negatively with %LAA. The %CSA<5 was lower in COPD patients with emphysema as compared with non-COPD smokers and COPD patients with or without mild emphysema. In addition, the %CSA<5 was lower in the no/mild emphysema subgroup as compared with non-COPD smokers. The respiratory phase change of %CSA<5 in COPD patients was greater than that in non-COPD smokers. CONCLUSION The percentage of small pulmonary vessels decreased as emphysematous changes increase, and this decrease was observed even in patients with no/mild emphysema. Furthermore, respiratory phase changes in CSA were higher in COPD patients than in non-COPD smokers.

Myocardial Fibrosis in Fabry Disease Demonstrated by Multislice Computed Tomography Comparison With Biopsy Findings

A54-year-old man presented with dyspnea on effort. Echocardiogram revealed reduced apical wall motion of the left ventricle (LV) with extreme hypertrophy of the interventricular septum (IVS). Conventional coronary angiogram showed normal coronary arteries. Endomyocardialbiopsy specimens obtained from the IVS revealed extensive vacuolization of cardiac myocytes and mild fibrosis on light microscopy, and typical lysosomal inclusions with a concentric lamellar configuration were seen with electron microscopy (Figure 1). With these findings and low plasma -galactosidase activity, he was diagnosed as having Fabry disease. To evaluate the characteristics of the LV, ECG-gated enhanced multislice computed tomography (CT) (Light Speed Ultra, General Electric) was performed with a 1.25-mm slice thickness, helical pitch 3.25. After intravenous injection of 100 mL of iodinated contrast material (350 mgI/mL), CT scanning was performed with retrospective ECG-gated reconstruction at 30 seconds and 8 minutes after injection. In the axial source images, extreme hypertrophy of the IVS and the posterior wall of the LV compared with the apical and lateral walls of the LV could be observed (Figure 2). The apical and lateral portions of the LV revealed lower CT intensity than the IVS in the early phase (arrows), and in the late phase they were abnormally enhanced compared with the IVS, suggesting fibrotic changes in the apical and lateral myocardium. Therefore, we concluded that despite the IVS biopsy results, more fibrotic changes occurred in the apical and lateral portions of the LV rather than in the IVS.A 54-year-old man presented with dyspnea on effort. Echocardiogram revealed reduced apical wall motion of the left ventricle (LV) with extreme hypertrophy of the interventricular septum (IVS). Conventional coronary angiogram showed normal coronary arteries. Endomyocardial-biopsy specimens obtained from the IVS revealed extensive vacuolization of cardiac myocytes and mild fibrosis on light microscopy, and typical lysosomal inclusions with a concentric lamellar configuration were seen with electron micros-copy (Figure 1). With these findings and low plasma α-galactosidase activity, he was diagnosed as having Fabry disease. To evaluate the characteristics of the LV, ECG-gated …

Images in cardiovascular medicine. Myocardial fibrosis in fabry disease demonstrated by multislice computed tomography: comparison with biopsy findings.

A54-year-old man presented with dyspnea on effort. Echocardiogram revealed reduced apical wall motion of the left ventricle (LV) with extreme hypertrophy of the interventricular septum (IVS). Conventional coronary angiogram showed normal coronary arteries. Endomyocardialbiopsy specimens obtained from the IVS revealed extensive vacuolization of cardiac myocytes and mild fibrosis on light microscopy, and typical lysosomal inclusions with a concentric lamellar configuration were seen with electron microscopy (Figure 1). With these findings and low plasma -galactosidase activity, he was diagnosed as having Fabry disease. To evaluate the characteristics of the LV, ECG-gated enhanced multislice computed tomography (CT) (Light Speed Ultra, General Electric) was performed with a 1.25-mm slice thickness, helical pitch 3.25. After intravenous injection of 100 mL of iodinated contrast material (350 mgI/mL), CT scanning was performed with retrospective ECG-gated reconstruction at 30 seconds and 8 minutes after injection. In the axial source images, extreme hypertrophy of the IVS and the posterior wall of the LV compared with the apical and lateral walls of the LV could be observed (Figure 2). The apical and lateral portions of the LV revealed lower CT intensity than the IVS in the early phase (arrows), and in the late phase they were abnormally enhanced compared with the IVS, suggesting fibrotic changes in the apical and lateral myocardium. Therefore, we concluded that despite the IVS biopsy results, more fibrotic changes occurred in the apical and lateral portions of the LV rather than in the IVS.A 54-year-old man presented with dyspnea on effort. Echocardiogram revealed reduced apical wall motion of the left ventricle (LV) with extreme hypertrophy of the interventricular septum (IVS). Conventional coronary angiogram showed normal coronary arteries. Endomyocardial-biopsy specimens obtained from the IVS revealed extensive vacuolization of cardiac myocytes and mild fibrosis on light microscopy, and typical lysosomal inclusions with a concentric lamellar configuration were seen with electron micros-copy (Figure 1). With these findings and low plasma α-galactosidase activity, he was diagnosed as having Fabry disease. To evaluate the characteristics of the LV, ECG-gated …