令和 2 年度

関西医科大学放射線科 Cutting edge セミナー

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日時:

SessionⅠ：令和 2 年 2 月 20 日(木) 18:00―
SessionⅡ：令和 2 年 3 月 5 日(木) 18:00―

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関西医科大学附属病院
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令和 2 年度

関西医科大学放射線科 Cutting edge セミナー
プログラム

平成 31 年 2 月 20 日(木)18:00【開会の辞】
狩谷 秀治 先生

(関西医科大学

18:10【SessionⅠ 診断①】
座長 広川 雄三 先生

(関西医大

放)

放)

1．MRI of prostate cancer: Trial of quantitative evaluation using ADC
Hiroaki Kurokawa, Kohzai Masasuke, Terazawa Rika, Ueno Yutaka, Kan Naoki
Hirokawa yuzo, Morise Satomi, Ikeda Shigeki, Tanigawa Noboru.

,

Kansai Medical University, Department of Radiology

2. Management of pulmonary nodule: difference between Japanese Society of CT
Screening and Fleischner Society
Osamu Honda, Yutaka Ueno, Naoki Kan, Satomi Morise, Asuka Kawaguchi, Rika
Terazawa, Masasuke Kohzai, Yuzo Hirokawa, Hiroaki Kurokawa, Noboru Tanigawa
Kansai Medical University, Department of Radiology

18:20【SessionⅡ IVR①】
座長 香西 雅介 先生

(関西医大

放)

3. Transarterial embolization for retained products of conception: outcome in 21 cases

Ono Y, Kariya S, Nakatani M, Ueno Y, Maruyama T, Komemushi A, Tanigawa N
Kansai Medical University, Department of Radiology

4．Changes in hepatic function after TACE in patients with HCC.
Takuji Maruyama1), Shuji Kariya1), Miyuki Nakatani1), Yutaka Ueno1), Yasuyuki Ono1),
Atsushi Komemushi1), Noboru Tanigawa1)
1) Department of Radiology, Kansai Medical University

18:40【SessionⅢ 核医学】
座長 上埜 泰寛 先生

(関西医大

放)

5．Parkinson 病とその他 parkinsonism の心交感神経と脳ドーパミントランスポーター機
能Kaoru Maruyama

6．Assessment of antitumor effect using Yttrium-90 lipiodol in a rat hepatocellular
carcinoma cell line.
Kono Y, Kan N, Matsumoto Y*, Sakurai S*, Sakata Y**, Ueno Y, Maruyama K,
Kariya S, Utsunomiya K, Tanigawa N.
Dept. of Radiology, Kansai Medical University

*Radioisotope Research Center, Kansai Medical Uceversity**Central Research of Laboratory, Kansai Medical University

7．Radioiodine (I-131) Ablation in Outpatient after Total Thyroidectomy for The
Differentiated Thyroid Cancer
Naoki Kan1), Keita Utsunomiya1), Yumiko Kono1), Kensuke Suzuki2), Hiroshi Iwai2),
Yasuhiro Ueno1), Kaoru Maruyama1) and Noboru Tanigawa1)
1) Department of Radiology, Kansai Medical University, Osaka, Japan
2) Department of Otolaryngology, Kansai Medical University, Osaka, Japan

令和 2 年 3 月 5 日(木)18:00【SessionⅠ IVR①】
座長 寺澤 理香 先生

(関西医大

放)

8. Analysis of factors influencing accuracy and complications in CT-guided lung biopsy
Miyuki Nakatani, Shuji Kariya, Yasuyuki Ono, Takuji Maruyama, Yutaka Ueno,
Atsushi Komemushi, Noboru Tanigawa
Kansai Medical University, Department of Radiology

9. Cavitation effect by ultrasonic irradiation under carbon dioxide nano-microb ubbles
in swine
Yutaka Ueno, Shuji Kariya, Yasuyuki Ono, Takuji Maruyama, Miyuki Nakatani,
Atsushi Komemushi, Noboru Tanigawa
Kansai Medical University, Department of Radiology

10.レントゲンカンファレンス
廣田 香月,

黒川 弘晶,

本田修抄録
1. 前立腺癌の MRI：ADC を用いた定量評価の試み
英文タイトル:
MRI of prostate cancer: Trial of quantitative evaluation using ADC
抄録本文:[Objective]The ADC value is not universal between equipment and facilities. We
examined what conditions would allow us to diagnose prostate cancer using apparent
diffusion coefficient (ADC) values.[Materials and Methods]Twenty-five lesions of 17
cases of prostate cancer were included in this study.For quantitative evaluation of ADC
value in diffusion weighted images, we examined differences between MRI devices,changes in ADC value by setting b value, and ADC values of bladder urine and 25
tumor lesions.[Results]The ADC value calculated with b values of 0 and 2000(s/mm2)
was 1800 to 2100 (×10-6 mm2 / sec) for bladder and urine, and there was no difference
between multiple MRI models. The ADC value of urinary bladder was very close to thatof distilled water in the urethral balloon. Urine in the bladder can be a phantom as anindicator of ADC values.Under the same imaging conditions, ADC values of 21 prostatecancer lesions visually confirmed by MRI averaged 670, and ADC values of 600 or lesswere all tumor lesions.The average ADC value of the non-tumor site in the transitionzone was 982.[Conclusion]The ADC value of urinary bladder was available as aphantom. If the urine was around 2000, the average ADC value of tumors visible on
MRI was 670.Less than 600 are highly suspected tumors.

2. Management of pulmonary nodule: difference between Japanese Society of CT
Screening and Fleischner Society
Osamu Honda, Yutaka Ueno, Naoki Kan, Satomi Morise, Asuka Kawaguchi, Rika
Terazawa, Masasuke Kohzai, Yuzo Hirokawa, Hiroaki Kurokawa, Noboru Tanigawa
Abstract
Pulmonary nodule can be found on CT examination. Those include not only malignant
tumor, but also benign tumor, infectious disease, and non-infectious disease. Somepulmonary nodules need further examination, some nodules need follow-up, and some

nodules need nothing to do. How to manage the pulmonary nodule is mainly decided by
the size and the feature of the nodule. Adenocarcinoma, squamous cell carcinoma, andsmall cell carcinoma are the popular high-grade malignant epithelial pulmonary tumors.
Adenocarcinoma has many subtypes which includes preinvasive lesions (atypicaladenomatous hyperplasia, adenocarcinoma in situ) and minimally invasive
adenocarcinoma, and it has many CT features (solid, part-solid nodule, and pureground-glass nodule). How to manage the pulmonary nodule in Japan is proposed by
Japanese Society of CT screening, and the follow-up interval is different between solid
nodule and part-solid nodule, and pure ground-glass nodule. On the other hand,
Fleischner Society, which is an international multidisciplinary medical society forthoracic radiology, also proposes its own principal for the management of pulmonary
nodule. In this presentation, we introduce the guideline of the management for thepulmonary nodule, and discuss the difference between Japanese Society of CT
screening and that of Fleischner Society.

3. Transarterial embolization for retained products of conception: outcome in 21 cases

Ono Y, Kariya S, Nakatani M, Ueno Y, Maruyama T, Komemushi A, Tanigawa N
Kansai Medical University, Department of Radiology[Objective]
The purpose of this study was to evaluate the results of transarterial embolization (TAE)for the retained products of conception (RPOC).
[Materials and Methods]
The subjects were 21 patients (mean age, 34 years; range, 23 - 53 years) who underwent
TAE for RPOC between 2006 and 2019.
Technical success was defined that stopping of the life-threatening hemorrhage wasconfirmed by internal examination immediately after embolization. Clinical success was
defined that complete hemostasis was obtained without surgical treatment for
hemorrhage after embolization.
[Results]
24 times of TAE were performed in 21 patients. Technical success rate was 100%.
Hysterectomy was performed in the three patients due to rebleeding. The clinicalsuccess rate was 85.7% (n = 18). Four cases were performed second TAE or second
angiography due to rebleeding or remaining blood flow in RPOC. The average intervalbetween TAE and hysterectomy was 3.25 days (range,0-7). The average interval
between TAE and second TAE was 7.33 days (range,4-13).
Type of delivery was 12 vaginal delivery, 2 planned Cesarean delivery, 6 emergency
Cesarean delivery, and 1 dilatation & curettage. RPOC was caused 8 cases of primary
postpartum hemorrhage (PPH) and 13 cases of secondary PPH.
[Conclusion]
TAE was effective for RPOC. Second TAE was also effective for rebleeding or
remaining blood flow in RPOC.

4. Changes in hepatic function after TACE in patients with HCC.
Takuji Maruyama1), Shuji Kariya1), Miyuki Nakatani1), Yutaka Ueno1), Yasuyuki Ono1),
Atsushi Komemushi1), Noboru Tanigawa1)
1) Department of Radiology, Kansai Medical University[Purpose]
To investigate the changes in liver function when transcatheter arterial
chemoembolization (TACE) was performed multiple times for hepatocellular carcinoma(HCC).
[Materials and Methods]
The subjects were 32 consecutive HCC patients who had undergone the first TACE
from January 2013 to August 2013, had a Child-Pugh Grade A before the first TACE,
and had undergone two or more TACEs. The Child-Pugh Score (CPS) and ALBI Score(AS) immediately before and three months after each TACE were examined. Patients
who underwent hepatectomy or chemotherapy other than TACE during the observation
period were excluded. The average value of CPS and AS before and after each TACE
was calculated. The difference between CPS and AS before and after each TACE andbefore the first TACE and after the third TACE was analyzed using Wilcoxon rank sum
test.
[Results]
The average values of CPS before and after each TACE were 5.37 before the first time,
5.41 after the first time, 5.74 before the second time, 5.65 after the second time, 5.73
before the third time, and 5.67 after the third time. The average values of AS before andafter each TACE were -2.64 before the first time, -2.53 after the first time, -2.42 before
the second time, -2.46 after the second time, -2.34 before the third time, -2.16 after thethird time. There was no significant difference in CPS and AS before and after each
TACE. Before the first TACE and after the third TACE, there was no significant

difference in CPS, but AS increased significantly.
[Conclusion]
CPS and AS did not change between before and after each TACE. CPS did not change
between before the first TACE and after the third TACE, but AS increased.

5. Parkinson 病とその他 parkinsonism の心交感神経と脳ドーパミントランスポータ
ー機能
Kaoru Maruyama
英文タイトル: Cardiac sympathetic function and brain dopamine transporter
function in Parkinson's disease and other parkinsonism
抄録本文: [Objective] To evaluate myocardial sympathetic imaging using
123I-meta-iodobenzylguanidine (MIBG) scintigraphy and striatal
presynaptic dopamine transporter imaging using 123I-Ioflupane (FP-CIT)
single photon emission computed tomography (SPECT) in patients withparkinsonism. [Materials and Methods] Fifty-seven patients who underwent
both methods for differential diagnosis between Parkinson's disease (PD,n = 37) and other parkinsonism (nonPD, n = 20) were enrolled. The nonPD
comprise progressive supranuclear palsy (n = 6), corticobasal degeneration(n = 4), multiple-system atrophy (n = 2), and others (n = 8). MIBG uptake
was evaluated as the heart to mediastinum count ratio (H/M) for early anddelayed images, and the heart washout rate (WR). [Results] For single useof MIBG delayed H/M, the sensitivity, specificity, accuracy, positive andnegative predictive values, in the clinical differentiation of PD from
nonPD, were 81%, 75%, 79%, 86%, and 68%, respectively; for single use ofWR, those were 84%, 55%, 74%, 78%, and 65%, respectively; for single useof FP-CIT, those were 100%, 40%, 79%, 76%, and 100%, respectively. For
combined use of delayed H/M and FP-CIT, the sensitivity, specificity,
accuracy, positive and negative predictive values were 81%, 85%, 82%, 91%,
and 71%, respectively. In PD group, both early and delayed H/M ratio was
not related to FP-CIT value (P &gt; 0.05). [Conclusion] The results suggestthat myocardial sympathetic uptake system and striatal dopaminetransporter system are differently affected in PD. By combining use of

FP-CIT and MIBG, accuracy can be raised. Complementary neuroimaging studies
with radiotracer may help in the differential diagnosis of parkinsonism.

6. Assessment of antitumor effect using Yttrium-90 lipiodol in a rat hepatocellular
carcinoma cell line.
Kono Y, Kan N, Matsumoto Y*, Sakurai S*, Sakata Y**, Ueno Y, Maruyama K,
Kariya S, Utsunomiya K, Tanigawa N.
Dept. of Radiology, Kansai Medical University*Radioisotope Research Center, Kansai Medical Uceversity**Central Research of Laboratory, Kansai Medical University[Objective] To investigate the effects of Yttrium-90 lipiodol via in-vivo a xenograft modelusing a rat hepatocellular carcinoma.

[Material and Methods] We made xonograft rats that implanted a rat hepatocellular carcinoma
cell (AH109A-TC) in subcutaneous tissue of bilateral shoulders (n=3) or bilateral femur
muscles (n=6). 90Y lipiodol (3.7MBq/100μL) were injected into unilateral subcutaneous tumors
via direct needle puncture (S-group), into unilateral femoral xenograft tumors by intra-arterial
administration(F-group, n=3) or an unlabeled lipiodol were injected into femoral xenograft
tumor by intra-arterial administration (C-group, n=3). All contralateral tumors were prepared ascontrols but in femoral tumor model, the femur artery on the control side was ligated. At 7 days
after injection, Growth suppression rate ware calculated. CT and imaging plate was performed
and tumor volume was compared to control tumor volume.

[Results] Target tumors of S-group were seen high accumulation of lipiodol than F-group andC-group in a week. However, the therapeutic effect was poor in the S-group. By contrast,
therapeutic effect was seen in the F-group and C-group, specifically F-group tumors was grownsmaller. Growth suppression rate of S-group, F-group and C-group ware 1.1±0.52, 0.1±0.03,
0.7±0.22 (Average±SE) respectively. In F-group and were seen lung accumulation of lipodol.
[Conclusion] Yttrium-90 lipiodol has a synergistic antitumor effect in arterial embolization.

7. Radioiodine (I-131) Ablation in Outpatient after Total Thyroidectomy for The
Differentiated Thyroid Cancer

Naoki Kan1), Keita Utsunomiya1), Yumiko Kono1), Kensuke Suzuki2), Hiroshi Iwai2),
Yasuhiro Ueno1), Kaoru Maruyama1) and Noboru Tanigawa1)
1) Department of Radiology, Kansai Medical University, Osaka, Japan
2) Department of Otolaryngology, Kansai Medical University, Osaka, Japan[Objective] To evaluate the clinical significance of I-131 ablation in patients withdifferentiated thyroid cancer.
[Subjects and Methods] Forty-three postoperative (total thyroidectomy) patients withdifferentiated thyroid cancer were studied. Thirty-one patients received total
thyroidectomy for thyroid cancer (Primary operation group) and 12 patients had total
thyroidectomy as a second operation (Reoperation group : subtotal thyroidectomy was
performed at first operation for thyroid cancer). All patients received I-131 30 mCi
ablation and SPECT/CT scans were performed to assess the thyroid bed accumulationof I-131 to evaluate the efficacy of ablation. Thyroglobulin (Tg) levels were measured
before and 6 months after I-131 ablation.
[Results] Ablation success rate was 64.3% in Primary operation group and 42.8% in
Reoperation group. Thyroid cancer recurrence rate after ablation was 3.2% in Primary
operation group and 33.3% in Reoperation group (p<0.05). Serum Tg level was tended
to be higher in Reoperation group than that in Primary operation group at 6 months after
ablation. Thyroid cancer recurrence was observed in 3 of 4 patients with ablation failure
in Reoperation group. Serum Tg level was higher in patients with recurrent disease (±)
compared to those without recurrence (±).
[Conclusion] Low-dose I-131 ablation is recommended following total thyroidectomy
in patients with high risk differentiated thyroid cancer. However, low-dose (30mCi)
I-131 ablation may not be effective for patients who had received surgery for
differentiated thyroid cancer and have previously had recurrent disease.

8. Analysis of factors influencing accuracy and complications in CT-guided lungbiopsyMiyuki Nakatani, Shuji Kariya, Yasuyuki Ono, Takuji Maruyama, Yutaka Ueno,
Atsushi Komemushi, Noboru Tanigawa

Kansai Medical University, Department of Radiology[Objective] This study aimed to analyze factors influencing accuracy and complications
in patients who underwent CT-guided lung biopsy at our medical center.
[Material and Methods] This study included 841 patients who underwent CT-guided
lung biopsy between January 2006 and March 2017. Final diagnosis, when surgicalresection was performed, was histopathological diagnosis from the lung lesion specimen,
and when resection was not performed, was clinical diagnosis after >6 months offollow-up. The accuracy of lung biopsy was assessed by comparison of biopsy results
and final diagnosis.
[Results] Accuracy of CT-guided lung biopsy was 95.5%. CT fluoroscopy was used in
93.1% of cases. Two patients whose sample could not be diagnosed histopathologicallyand 190 patients whose final diagnosis was undetermined were excluded from
evaluation of accuracy. The factors, including lesion size, lesion depth from pleura,lesion location and patient position, had no significant influence on accuracy. The
complications were Grade 1 and 2 pneumothorax and Grade 1, 2 and 3 bleeding.
[Conclusion] CT-guided lung biopsy had a diagnostic accuracy rate of 95.5%.
Pneumothorax and bleeding sometimes occurred as complications.

9. Cavitation effect by ultrasonic irradiation under carbon dioxide nano-microb ubbles
in swine
Yutaka Ueno, Shuji Kariya, Yasuyuki Ono, Takuji Maruyama, Miyuki Nakatani,
Atsushi Komemushi, Noboru Tanigawa
Kansai Medical University, Department of Radiology[Objective]It is known that the physical impact of the cavitation effect cre ates a
temporary hole in the cell membrane, facilitating the entry and exit of substances
through the cell membrane. We investigated whether cisplatin t ranslocation of the cell
membrane was enhanced by inducing cavitation by ult rasonic irradiation under carbon
dioxide nano-microbubbles in swine liver ti ssue.
[Materials and Methods]Six swines were used. By percutaneous placed cat heter, 100
ml of cisplatin and 100 ml of carbon dioxide nano-microbubbles (concentration: 1.07 to
2.50*109 / ml) were simultaneously administered from t he hepatic artery. The pig waslaparotomized, and the left inner lobe of the liver was ultrasonically irradiated (output
10W, frequency 3MHz) from the l iver surface to induce cavitation. After that, theswine were euthanized and tissue was excised from both the inner left lobe withultrasonically irradi ated and the inner right lobe without ultrasonically irradiated. The
excised specimens were each measured for cisplatin concentration.
[Results]The cispl atin concentration of the excised specimens was significantly higher
in the medial left lobe with induced cavitation, averaging 6266.7 (SD 2841.2) ng/g inthe medial left lobe and 2700.0 (SD 63612) ng/g in the medial right lobe. (P = 0.03).
[Conclusion]Cell membrane migration was enhanced in cavitation-i nduced liver tissue,
and drug migration was increased. In this study, we sho wed that cavitation can be usedin swine.