Research activity information

• Jul. 2023 前之園記念若手優秀論文賞


• Jun. 2023 神戸大学放射線科同門会, 海外学術発表奨励賞, RSNA 2022: Rim enhancement on contrast-enhanced CT as a predictor of prognosis in patients with pancreatic ductal adenocarcinoma

• Advantages of deep learning reconstruction algorithm in ultra-high-resolution CT for the diagnosis of pancreatic cystic neoplasm

  Keitaro Sofue, Yoshiko Ueno, Shinji Yabe, Eisuke Ueshima, Takeru Yamaguchi, Atsuhiro Masuda, Arata Sakai, Hirochika Toyama, Takumi Fukumoto, Masatoshi Hori, Takamichi Murakami

  Abstract Purpose This study aimed to evaluate the image quality and clinical utility of a deep learning reconstruction (DLR) algorithm in ultra-high-resolution computed tomography (UHR-CT) for the diagnosis of pancreatic cystic neoplasms (PCNs). Methods This retrospective study included 45 patients with PCNs between March 2020 and February 2022. Contrast-enhanced UHR-CT images were obtained and reconstructed using DLR and hybrid iterative reconstruction (IR). Image noise and contrast-to-noise ratio (CNR) were measured. Two radiologists assessed the diagnostic performance of the imaging findings associated with PCNs using a 5-point Likert scale. The diagnostic performance metrics, including sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC), were calculated. Quantitative and qualitative features were compared between CT with DLR and hybrid IR. Interobserver agreement for qualitative assessments was also analyzed. Results DLR significantly reduced image noise and increased CNR compared to hybrid IR for all objects (p < 0.001). Radiologists rated DLR images as superior in overall quality, lesion delineation, and vessel conspicuity (p < 0.001). DLR produced higher AUROC values for diagnostic imaging findings (ductal communication: 0.887‒0.938 vs. 0.816‒0.827 and enhanced mural nodule: 0.843‒0.916 vs. 0.785‒0.801), although DLR did not directly improve sensitivity, specificity, and accuracy. Interobserver agreement for qualitative assessments was higher in CT with DLR (κ = 0.69‒0.82 vs. 0.57‒0.73). Conclusion DLR improved image quality and diagnostic performance by effectively reducing image noise and improving lesion conspicuity in the diagnosis of PCNs on UHR-CT. The DLR demonstrated greater diagnostic confidence for the assessment of imaging findings associated with PCNs.

  May 2025, Japanese Journal of Radiology, English

  Scientific journal


• Improved Image Quality of Virtual Monochromatic Images with Deep Learning Image Reconstruction Algorithm on Dual-Energy CT in Patients with Pancreatic Ductal Adenocarcinoma

  Keitaro Sofue, Eisuke Ueshima, Yoshiko Ueno, Takeru Yamaguchi, Masatoshi Hori, Takamichi Murakami

  Abstract This study aimed to evaluate the image quality of virtual monochromatic images (VMIs) reconstructed with deep learning image reconstruction (DLIR) using dual-energy CT (DECT) to diagnose pancreatic ductal adenocarcinoma (PDAC). Fifty patients with histologically confirmed PDAC who underwent multiphasic contrast-enhanced DECT between 2019 and 2022 were retrospectively analyzed. VMIs at 40–100 keV were reconstructed using hybrid iterative reconstruction (ASiR-V 30% and ASiR-V 50%) and DLIR (TFI-M) algorithms. Quantitative analyses included contrast-to-noise ratios (CNR) of the major abdominal vessels, liver, pancreas, and the PDAC. Qualitative image quality assessments included image noise, soft-tissue sharpness, vessel contrast, and PDAC conspicuity. Noise power spectrum (NPS) analysis was performed to examine the variance and spatial frequency characteristics of image noise using a phantom. TFI-M significantly improved image quality compared to ASiR-V 30% and ASiR-V 50%, especially at lower keV levels. VMIs with TFI-M showed reduced image noise and higher pancreas-to-tumor CNR at 40 keV. Qualitative evaluations confirmed DLIR's superiority in noise reduction, tissue sharpness, and vessel conspicuity, with substantial interobserver agreement (κ = 0.61–0.78). NPS analysis demonstrated effective noise reduction across spatial frequencies. DLIR significantly improved the image quality of VMIs on DECT by reducing image noise and increasing CNR, particularly at lower keV levels. These improvements may improve PDAC detection and assessment, making it a valuable tool for pancreatic cancer imaging.

  Springer Science and Business Media LLC, Apr. 2025, Journal of Imaging Informatics in Medicine

  Scientific journal


• Immunoscore Predicted by Dynamic Contrast-Enhanced Computed Tomography Can Be a Non-Invasive Biomarker for Immunotherapy Susceptibility of Hepatocellular Carcinoma.

  Eisuke Ueshima, Keitaro Sofue, Shohei Komatsu, Nobuaki Ishihara, Masato Komatsu, Akihiro Umeno, Kentaro Nishiuchi, Ryohei Kozuki, Takeru Yamaguchi, Takanori Matsuura, Toshifumi Tada, Takamichi Murakami

  Background/Objectives: Although immunotherapy is the primary treatment option for intermediate-stage hepatocellular carcinoma (HCC), its efficacy varies. This study aimed to identify non-invasive imaging biomarkers predictive of the immunoscore linked to dynamic contrast-enhanced computed tomography (CECT). Methods: We performed immunohistochemical staining with CD3+ and CD8+ antibodies and counted the positive cells in the invasive margin (IM) and central tumor (CT), converting them to an immunoscore of 0 to 4 points. We assessed the dynamic CECT findings obtained from 96 patients who underwent hepatectomy for HCC and evaluated the relationship between dynamic CECT findings and immunoscores. For validation, we assessed the treatment effects on 81 nodules using the Response Evaluation Criteria in Solid Tumors in another cohort of 41 patients who received combined immunotherapy with atezolizumab and bevacizumab (n = 27) and durvalumab and tremelizumab (n = 14). Results: HCCs with peritumoral enhancement in the arterial phase (p < 0.001) and rim APHE (p = 0.009) were associated with the immunoscore in univariate linear regression analysis and peritumoral enhancement in the arterial phase (p = 0.004) in multivariate linear regression analysis. The time to nodular progression in HCCs with peritumoral enhancement in the arterial phase was significantly longer than that in HCCs without this feature (p < 0.001). Conclusions: We identified HCCs with peritumoral enhancement in the arterial phase as a noninvasive imaging biomarker to predict immune-inflamed HCC with a high immunoscore tendency. These HCCs were most likely to respond to combined immunotherapy.

  Mar. 2025, Cancers, 17(6) (6), English, International magazine

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• Gadoxetic Acid-Enhanced Magnetic Resonance Imaging Features Can Predict Immune-Excluded Phenotype of Hepatocellular Carcinoma

  Eisuke Ueshima, Keitaro Sofue, Takahiro Kodama, Shuhei Yamamoto, Masato Komatsu, Shohei Komatsu, Nobuaki Ishihara, Akihiro Umeno, Takeru Yamaguchi, Masatoshi Hori, Takumi Fukumoto, Tetsuo Takehara, Takamichi Murakami

  Introduction: Immunotherapy is the first-line treatment for intermediate-advanced stage hepatocellular carcinoma (HCC), although its outcomes vary. This study aimed to identify imaging biomarkers of immunotherapy susceptibility linked to gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) and immune phenotypes, particularly immune-excluded phenotypes, with a tumor immune barrier.Methods: We performed immunohistochemical staining with a CD8+ antibody, and samples were classified into immune-inflamed, -intermediate, -excluded, and -ignored phenotypes. We assessed EOB-MRI findings obtained from 104 patients who underwent hepatectomy for HCC and evaluated the relationship between MRI findings and immune phenotype. Spatial transcriptome analysis of tumor tissues in each immune phenotype was performed to characterize the MRI findings. For validation, we analyzed the treatment effect on 60 nodules in another cohort of 27 patients who received combined immunotherapy using anti-programmed death-ligand 1 and anti-vascular endothelial growth factor (VEGF) antibodies.Results: HCCs with rim arterial phase hyperenhancement (APHE) (odds ratio [OR] 17.3 P=0.009), peritumoral enhancement on the arterial phase (OR 8.6, P<0.004), and intermediate intensity on the hepatobiliary phase (HBP) measured with a visual 3-point scale (OR 28.2, P=0.002) were associated with immune-excluded phenotype, where tumors tended to be larger and of the single nodular type with extranodular growth and confluent multinodular rather than the simple nodular type. Spatial transcriptome analysis revealed a spatial relationship among cytotoxic T lymphocytes, VEGF signals, and cancer-associated fibroblasts at the tumor-invasive margins in this phenotype. From the validation study, nodules with any one of these three imaging findings had a significantly prolonged time to-nodular progression (P=0.007, median not reached vs. 226 days).Conclusion: HCCs with rim APHE, peritumoral enhancement on arterial phase, and intermediate intensity on HBP with visual 3-point scale could be non-invasive biomarkers to predict the immune-excluded phenotype with tumor immune barrier. These HCCs were most likely to respond to the combined immunotherapy.

  S. Karger AG, Nov. 2024, Liver Cancer, 1 - 26

  [Refereed]

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• Utility of Thin-slice Fat-suppressed Single-shot T2-weighted MR Imaging with Deep Learning Image Reconstruction as a Protocol for Evaluating the Pancreas.

  Ryuji Shimada, Keitaro Sofue, Yoshiko Ueno, Tetsuya Wakayama, Takeru Yamaguchi, Eisuke Ueshima, Akiko Kusaka, Masatoshi Hori, Takamichi Murakami

  PURPOSE: To compare the utility of thin-slice fat-suppressed single-shot T2-weighted imaging (T2WI) with deep learning image reconstruction (DLIR) and conventional fast spin-echo T2WI with DLIR for evaluating pancreatic protocol. METHODS: This retrospective study included 42 patients (mean age, 70.2 years) with pancreatic cancer who underwent gadoxetic acid-enhanced MRI. Three fat-suppressed T2WI, including conventional fast-spin echo with 6 mm thickness (FSE 6 mm), single-shot fast-spin echo with 6 mm and 3 mm thickness (SSFSE 6 mm and SSFSE 3 mm), were acquired for each patient. For quantitative analysis, the SNRs of the upper abdominal organs were calculated between images with and without DLIR. The pancreas-to-lesion contrast on DLIR images was also calculated. For qualitative analysis, two abdominal radiologists independently scored the image quality on a 5-point scale in the FSE 6 mm, SSFSE 6 mm, and SSFSE 3 mm with DLIR. RESULTS: The SNRs significantly improved among the three T2-weighted images with DLIR compared to those without DLIR in all patients (P < 0.001). The pancreas-to-lesion contrast of SSFSE 3 mm was higher than those of the FSE 6 mm (P < 0.001) and tended to be higher than SSFSE 6 mm (P = 0.07). SSFSE 3 mm had the highest image qualities regarding pancreas edge sharpness, pancreatic duct clarity, and overall image quality, followed by SSFSE 6 mm and FSE 6 mm (P < 0.0001). CONCLUSION: SSFSE 3 mm with DLIR demonstrated significant improvements in SNRs of the pancreas, pancreas-to-lesion contrast, and image quality more efficiently than did SSFSE 6 mm and FSE 6 mm. Thin-slice fat-suppressed single-shot T2WI with DLIR can be easily implemented for pancreatic MR protocol.

  Jun. 2024, Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine, English, Domestic magazine

  [Refereed]

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• Rim Enhancement on Contrast-Enhanced CT as a Predictor of Prognosis in Patients with Pancreatic Ductal Adenocarcinoma

  Takeru Yamaguchi, Keitaro Sofue, Eisuke Ueshima, Naoki Sugiyama, Shinji Yabe, Yoshiko Ueno, Atsuhiro Masuda, Hirochika Toyama, Takayuki Kodama, Masato Komatsu, Masatoshi Hori, Takamichi Murakami

  This study investigated the utility of imaging features, such as rim enhancement on contrast-enhanced CT (CECT), in predicting the prognosis of pancreatic ductal adenocarcinoma (PDAC). This retrospective study included 158 patients (84 men; mean age, 68 years) with pathologically confirmed PDAC. The following imaging features were evaluated on CECT by two radiologists: tumor size, tumor attenuation, and the presence of rim enhancement. Cox proportional hazards analysis was performed to identify the imaging and clinicopathological features for predicting disease-free survival (DFS) and overall survival (OS). Pathological features were compared with the presence of rim enhancement. Among the 158 patients, 106 (67%) underwent curative surgery (surgery group) and 52 (33%) received conservative treatment (non-surgery group). Rim enhancement was observed more frequently in the non-surgery group than in the surgery group (44% vs. 20%; p < 0.001). Rim enhancement showed significant associations with shorter DFS and OS in the surgery group (hazard ratios (HRs), 3.03 and 2.99; p < 0.001 and p = 0.003, respectively), whereas tumor size showed significant associations with shorter OS (HR per 1 mm increase, 1.08; p < 0.001). PDACs with rim enhancement showed significant associations with higher histological tumor grades (p < 0.001). PDAC with rim enhancement on CECT could predict poorer prognosis and more aggressive tumor grades.

  Lead, MDPI AG, Apr. 2024, Diagnostics, 14(8) (8), 782 - 782, English

  [Refereed]

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• Evaluation and Prediction of Post-Hepatectomy Liver Failure Using Imaging Techniques: Value of Gadoxetic Acid-Enhanced Magnetic Resonance Imaging

  Keitaro Sofue, Ryuji Shimada, Eisuke Ueshima, Shohei Komatsu, Takeru Yamaguchi, Shinji Yabe, Yoshiko Ueno, Masatoshi Hori, Takamichi Murakami

  XMLink, Jan. 2024, Korean Journal of Radiology, 25(1) (1), 24 - 24

  [Refereed]

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• Added value of contrast enhancement boost images in routine multiphasic contrast-enhanced CT for the diagnosis of small (<20 mm) hypervascular hepatocellular carcinoma.

  Shinji Yabe, Keitaro Sofue, Masatoshi Hori, Tomoki Maebayashi, Megumi Nishigaki, Yushi Tsujita, Takeru Yamaguchi, Eisuke Ueshima, Yoshiko Ueno, Takamichi Murakami

  PURPOSE: To investigate the added value of contrast enhancement boost (CE-boost) images in multiphasic contrast-enhanced CT (CE-CT) for diagnosing small (<20 mm) hypervascular hepatocellular carcinoma (HCC). MATERIALS AND METHODS: This retrospective study included 69 patients (age, 74 ± 8 years; 52 men) with 70 hypervascular HCCs (<20 mm) who underwent multiphasic CE-CT (pre-contrast, late arterial phase [LAP], portal venous phase [PVP], and equilibrium phase). Two types of CE-boost images were generated by subtracting PVP from LAP (LA-PV) images and LAP from PVP (PV-LA) images to enhance the contrast effect of hepatic arterial and portal venous perfusion more selectively. Tumor-to-liver contrast-to-noise ratios (CNRs) in CE-boost images were compared with those in CE-CT images using the Wilcoxon signed-rank test. Two independent readers reviewed the imaging datasets: CE-CT alone and CE-CT with CE-boost images. The diagnostic performance of each dataset was compared using jackknife alternative free-response receiver operating characteristics (JAFROC-1). RESULTS: The tumor-to-liver CNRs in the LA-PV (6.4 ± 3.0) and PV-LA (-3.3 ± 2.1) images were greater than those in the LAP (3.2 ± 1.7) and PVP images (-1.1 ± 1.4) (p <.001 for both). The reader-averaged figures of merit were 0.751 for CE-CT alone and 0.807 for CE-CT with CE-boost images (p <.001). Sensitivities increased by adding CE-boost images for both readers (p <.001 and = 0.03), while positive predictive values were equivalent (p >.99). CONCLUSION: Adding CE-boost images to multiphasic CE-CT can improve the diagnostic accuracy and sensitivity for small hypervascular HCC by increasing the tumor-to-liver CNR.

  Mar. 2023, European journal of radiology, 160, 110696 - 110696, English, International magazine

  [Refereed]

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• Deep learning image reconstruction to improve accuracy of iodine quantification and image quality in dual-energy CT of the abdomen: a phantom and clinical study

  Akiyo Fukutomi, Keitaro Sofue, Eisuke Ueshima, Noriyuki Negi, Yoshiko Ueno, Yushi Tsujita, Shinji Yabe, Takeru Yamaguchi, Ryuji Shimada, Akiko Kusaka, Masatoshi Hori, Takamichi Murakami

  OBJECTIVES: To investigate the effect of deep learning image reconstruction (DLIR) on the accuracy of iodine quantification and image quality of dual-energy CT (DECT) compared to that of other reconstruction algorithms in a phantom experiment and an abdominal clinical study. METHODS: An elliptical phantom with five different iodine concentrations (1-12 mgI/mL) was imaged five times with fast-kilovoltage-switching DECT for three target volume CT dose indexes. All images were reconstructed using filtered back-projection, iterative reconstruction (two levels), and DLIR algorithms. Measured and nominal iodine concentrations were compared among the algorithms. Contrast-enhanced CT of the abdomen with the same scanner was acquired in clinical patients. In arterial and portal venous phase images, iodine concentration, image noise, and coefficients of variation for four locations were retrospectively compared among the algorithms. One-way repeated-measures analyses of variance were used to evaluate differences in the iodine concentrations, standard deviations, coefficients of variation, and percentages of error among the algorithms. RESULTS: In the phantom study, the measured iodine concentrations were equivalent among the algorithms: within ± 8% of the nominal values, with root-mean-square deviations of 0.08-0.36 mgI/mL, regardless of radiation dose. In the clinical study (50 patients; 35 men; mean age, 68 ± 11 years), iodine concentrations were equivalent among the algorithms for each location (all p > .99). Image noise and coefficients of variation were lower with DLIR than with the other algorithms (all p < .01). CONCLUSIONS: The DLIR algorithm reduced image noise and variability of iodine concentration values compared with other reconstruction algorithms in the fast-kilovoltage-switching dual-energy CT. KEY POINTS: • In the phantom study, standard deviations and coefficients of variation in iodine quantification were lower on images with the deep learning image reconstruction algorithm than on those with other algorithms. • In the clinical study, iodine concentrations of measurement location in the upper abdomen were consistent across four reconstruction algorithms, while image noise and variability of iodine concentrations were lower on images with the deep learning image reconstruction algorithm.

  Springer Science and Business Media LLC, Sep. 2022, European Radiology, 33(2) (2), 1388 - 1399, English, International magazine

  [Refereed]

  Scientific journal


• Transarterial Chemoebolization in Hepatocellular Carcinoma: A Binational Japanese-German Study

  Timo A Auer, Keitaro Sofue, Eisuke Ueshima, Nina Rauer, Takeru Yamaguchi, Bernhard Gebauer, Bernd Hamm, Takamichi Murakami, Christian Althoff

  OBJECTIVE: The purpose of this study was to investigate outcomes of transarterial chemoembolization (TACE) in treating hepatocellular carcinoma (HCC) comparing the different approaches used in Germany and Japan. METHODS: This binational IRB-approved retrospective dual-center study included a total of 94 HCC patients subdivided in a German and a Japanese cohort. For each patient, liver and tumor volumetry was performed using computed tomography (CT) and magnetic resonance imaging (MRI). Furthermore, a comprehensive risk profile, including body constitution and liver and kidney function was established. Primary endpoints were progression-free and overall survival (PFS/OS). RESULTS: PFS in the German cohort was 168 vs 224d in the Japanese cohort (p=0.640). When subdivided by BCLC stage, no significant differences were reported (p=0.160-0.429). OS was significantly longer in the Japanese cohort with 856 vs. 303d (p<0.001). OS for BCLC A was significantly longer in the Japanese cohort (1960 vs. 428d; p<0.001), while survival rates did not differ significantly in BCLC B (785 vs 330d; p=0.067) and C-stages (208 vs 302d; p=0.186). Older age (p=0.034), poorer liver/kidney function (p=0.025-0-035), and a higher liver/tumor ratio (p<0.001) were found to correlate with shorter survival. ECOG scores were significantly higher in the German cohort (p=0.002). CONCLUSION: While OS is longer in TACE-treated patients in the Japanese cohort compared to the German cohort, the two approaches seem to be equally effective as PFS does not differ significantly. The different survival rates may be caused by the different clinical performance status of the selected collectives. In very early and early stage HCC, TACE in Japan seems to be an effective treatment option while in Germany for patients in those stages TACE remains a second-line option for patients not available for surgery or ablation.

  Informa UK Limited, Aug. 2022, Journal of Hepatocellular Carcinoma, Volume 9, 695 - 705, English, International magazine

  [Refereed]

  Scientific journal


• 123I-MIBGシンチグラフィで腎に異常集積を認めた腎動脈解離の1例

  杉山 朋加, 辻田 有志, 神田 知紀, 山口 尊, 矢部 慎二, 上嶋 英介, 上野 嘉子, 河野 淳, 祖父江 慶太郎, 野上 宗伸, 堀 雅敏, 村上 卓道

  (公社)日本医学放射線学会, Feb. 2022, Japanese Journal of Radiology, 40(Suppl.) (Suppl.), 39 - 39, Japanese


• Abbreviated Gadoxetic Acid‐Enhanced MRI for the Detection of Liver Metastases in Patients With Potentially Resectable Pancreatic Ductal Adenocarcinoma

  Takeru Yamaguchi, Keitaro Sofue, Eisuke Ueshima, Yoshiko Ueno, Yushi Tsujita, Shinji Yabe, Sachiyo Shirakawa, Hirochika Toyama, Masatoshi Hori, Takumi Fukumoto, Takamichi Murakami

  BACKGROUND: Gadoxetic acid-enhanced magnetic resonance imaging (MRI) is useful in detecting liver metastases from pancreatic ductal adenocarcinoma (PDAC). However, the long examination time limits its utility in the initial workup of patients with PDAC. PURPOSE: To evaluate the incremental value of an abbreviated gadoxetic acid-enhanced MRI for the detection of liver metastases in patients with PDAC. STUDY TYPE: Retrospective. POPULATION: Patients (N = 130) with potentially resectable PDAC (women, 58 [44.6%]). FIELD STRENGTH/SEQUENCE: 1.5 T and 3 T; gradient dual-echo T1-weighted (in-phase and opposed-phase), fat-suppressed fast spin-echo T2-weighted, single-shot echo-planar diffusion-weighted, and three-dimensional fat-suppressed T1-weighted gradient-echo dynamic contrast-enhanced and hepatobiliary phase sequences, as well as contrast-enhanced computed tomography (CECT). ASSESSMENT: Three radiologists independently reviewed three different image sets to detect liver metastases: set 1, CECT alone; set 2, CECT and abbreviated MRI comprising fat-suppressed T2-weighted, diffusion-weighted, and hepatobiliary phase images; and set 3, CECT and standard gadoxetic acid-enhanced MRI. STATISTICAL TESTS: Figure of merit (FOM) was compared using the jackknife alternative free-response receiver operating characteristics, and other per-lesion and per-patient diagnostic parameters for each image set were compared using McNemar's and Fisher's test. P < 0.05 was considered statistically significant. RESULTS: A total of 43 liver metastases were identified in 13 patients. Reader-averaged FOM to detect liver metastases were significantly higher for sets 2 (0.884) and 3 (0.886) than for set 1 (0.609), while they were comparable between sets 2 and 3 (P = 0.96). The mean per-patient sensitivities, negative predictive values, and accuracies were significantly higher for sets 2 and 3 than for set 1, while those between sets 2 and 3 were not significantly different (not applicable, P > 0.99, and P > 0.99, respectively). DATA CONCLUSION: Gadoxetic acid-enhanced MRI combined with CECT had higher diagnostic performance than CECT alone for the detection of liver metastases in patients with PDAC. The incremental values were comparable for the abbreviated MRI and standard MRI. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

  Lead, Wiley, Jan. 2022, Journal of Magnetic Resonance Imaging, 56(3) (3), 725 - 736, English, International magazine

  [Refereed]

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• Estimation of pancreatic fibrosis and prediction of postoperative pancreatic fistula using extracellular volume fraction in multiphasic contrast-enhanced CT.

  Keitaro Sofue, Eisuke Ueshima, Atsuhiro Masuda, Sachiyo Shirakawa, Yoh Zen, Yoshiko Ueno, Yushi Tsujita, Takeru Yamaguchi, Shinji Yabe, Takeshi Tanaka, Noriko Inomata, Hirochika Toyama, Takumi Fukumoto, Yuzo Kodama, Takamichi Murakami

  OBJECTIVE: To investigate the diagnostic performance of the extracellular volume (ECV) fraction in multiphasic contrast-enhanced computed tomography (CE-CT) for estimating histologic pancreatic fibrosis and predicting postoperative pancreatic fistula (POPF). METHODS: Eighty-five patients (49 men; mean age, 69 years) who underwent multiphasic CE-CT followed by pancreaticoduodenectomy with pancreaticojejunal anastomosis between January 2012 and December 2018 were retrospectively included. The ECV fraction was calculated from absolute enhancements of the pancreas and aorta between the precontrast and equilibrium-phase images, followed by comparisons among histologic pancreatic fibrosis grades (F0‒F3). The diagnostic performance of the ECV fraction in advanced fibrosis (F2‒F3) was evaluated using receiver operating characteristic curve analysis. Multivariate logistic regression analysis was used to evaluate the associations of the risk of POPF development with patient characteristics, histologic findings, and CT imaging parameters. RESULTS: The mean ECV fraction of the pancreas was 34.4% ± 9.5, with an excellent intrareader agreement of 0.811 and a moderate positive correlation with pancreatic fibrosis (r = 0.476; p < 0.001). The mean ECV fraction in advanced fibrosis was significantly higher than that in no/mild fibrosis (44.4% ± 10.8 vs. 31.7% ± 6.7; p < 0.001), and the area under the receiver operating characteristic curve for the diagnosis of advanced fibrosis was 0.837. Twenty-two patients (25.9%) developed clinically relevant POPF. Multivariate logistic regression analysis demonstrated that the ECV fraction was a significant predictor of POPF. CONCLUSIONS: The ECV fraction can offer quantitative information for assessing pancreatic fibrosis and POPF after pancreaticojejunal anastomosis. KEY POINTS: • There was a moderate positive correlation of the extracellular volume (ECV) fraction of the pancreas in contrast-enhanced CT with the histologic grade of pancreatic fibrosis (r = 0.476; p < 0.001). • The ECV fraction was higher in advanced fibrosis (F2‒F3) than in no/mild fibrosis (F0‒F1) (p < 0.001), with an AUC of 0.837 for detecting advanced fibrosis. • The ECV fraction was an independent risk factor for predicting subclinical (odds ratio, 0.81) and clinical (odds ratio, 0.80) postoperative pancreatic fistula.

  Oct. 2021, European radiology, 32(3) (3), 1770 - 1780, English, International magazine

  [Refereed]

  Scientific journal


• CT Body Composition of Sarcopenia and Sarcopenic Obesity: Predictors of Postoperative Complications and Survival in Patients with Locally Advanced Esophageal Adenocarcinoma.

  Uli Fehrenbach, Tilo Wuensch, Pia Gabriel, Laura Segger, Takeru Yamaguchi, Timo Alexander Auer, Nick Lasse Beetz, Christian Denecke, Dino Kröll, Jonas Raakow, Sebastian Knitter, Sascha Chopra, Peter Thuss-Patience, Johann Pratschke, Bernd Hamm, Matthias Biebl, Dominik Geisel

  BACKGROUND: To assess the impact of body composition imaging biomarkers in computed tomography (CT) on the perioperative morbidity and survival after surgery of patients with esophageal cancer (EC). METHODS: Eighty-five patients who underwent esophagectomy for locally advanced EC after neoadjuvant therapy between 2014 and 2019 were retrospectively enrolled. Pre- and postoperative CT scans were used to assess the body composition imaging biomarkers (visceral (VAT) and subcutaneous adipose tissue (SAT) areas, psoas muscle area (PMA) and volume (PMV), total abdominal muscle area (TAMA)). Sarcopenia was defined as lumbar skeletal muscle index (LSMI) ≤38.5 cm2/m2 in women and ≤52.4 cm2/m2 in men. Patients with a body mass index (BMI) of ≥30 were considered obese. These imaging biomarkers were correlated with major complications, anastomotic leakage, postoperative pneumonia, duration of postoperative hospitalization, disease-free survival (DFS), and overall survival (OS). RESULTS: Preoperatively, sarcopenia was identified in 58 patients (68.2%), and sarcopenic obesity was present in 7 patients (8.2%). Sarcopenic patients were found to have an elevated risk for the occurrence of major complications (OR: 2.587, p = 0.048) and prolonged hospitalization (32 d vs. 19 d, p = 0.040). Patients with sarcopenic obesity had a significantly higher risk for postoperative pneumonia (OR: 6.364 p = 0.018) and a longer postoperative hospital stay (71 d vs. 24 d, p = 0.021). Neither sarcopenia nor sarcopenic obesity was an independent risk factor for the occurrence of anastomotic leakage (p > 0.05). Low preoperative muscle biomarkers (PMA and PMV) and their decrease (ΔPMV and ΔTAMA) during the follow-up period significantly correlated with shorter DFS and OS (p = 0.005 to 0.048). CONCLUSION: CT body composition imaging biomarkers can identify high-risk patients with locally advanced esophageal cancer undergoing surgery. Sarcopenic patients have a higher risk of major complications, and patients with sarcopenic obesity are more prone to postoperative pneumonia. Sarcopenia and sarcopenic obesity are both subsequently associated with a prolonged hospitalization. Low preoperative muscle mass and its decrease during the postoperative follow-up are associated with lower DFS and OS.

  Jun. 2021, Cancers, 13(12) (12), English, International magazine

  [Refereed]

  Scientific journal


• Prediction of post-hepatectomy liver failure using gadoxetic acid-enhanced magnetic resonance imaging for hepatocellular carcinoma with portal vein invasion.

  Yushi Tsujita, Keitaro Sofue, Shohei Komatsu, Takeru Yamaguchi, Eisuke Ueshima, Yoshiko Ueno, Tomonori Kanda, Takuya Okada, Munenobu Nogami, Masato Yamaguchi, Masakatsu Tsurusaki, Masatoshi Hori, Takumi Fukumoto, Takamichi Murakami

  PURPOSE: Accurate prediction of post-hepatectomy liver failure (PHLF) is important in advanced hepatocellular carcinoma (HCC). We aimed to retrospectively evaluate the utility of gadoxetic acid-enhanced MRI for predicting PHLF in patients who underwent anatomic hepatectomy for HCC with portal vein invasion. METHODS: Forty-one patients (32 men, 9 women) were included. Hepatobiliary-phase MR images were acquired 20 min after injection of gadoxetic acid using a 3D fat-suppressed T1-weighted spoiled gradient-echo sequence. Liver-spleen ratio (LSR), remnant hepatocellular uptake index (rHUI), and HUI were calculated. The severity of PHLF was defined according to the International Study Group of Liver Surgery. Differences in LSR between the resected liver and the remnant liver, and HUI and rHUI/HUI between no/mild and severe PHLF were compared using the Wilcoxon signed-rank test and Wilcoxon rank-sum test, respectively. Univariate and multivariate logistic regression analyses were performed to identify predictors of severe PHLF. Areas under the receiver operating characteristic curves (AUCs) of rHUI and rHUI/HUI were calculated for predicting severe PHLF. RESULTS: Nine patients developed severe PHLF. LSR of the remnant liver was significantly higher than that of the resected liver (P < 0.001). Severe PHLF demonstrated significantly lower rHUI (P < 0.001) and rHUI/HUI (P < 0.001) compared with no/mild PHLF. Multivariate logistic regression analysis showed that decreased rHUI (P = 0.012, AUC=0.885) and rHUI/HUI (P = 0.002, AUC=0.852) were independent predictors of severe PHLF. CONCLUSION: Gadoxetic acid-enhanced MRI can be a promising noninvasive examination for assessing global and regional liver function, allowing estimation of the functional liver remnant and accurate prediction of severe PHLF before hepatic resection.

  Sep. 2020, European journal of radiology, 130, 109189 - 109189, English, International magazine

  [Refereed]

  Scientific journal


• Protein Plug in the Pancreatic Duct Mimicking Pancreatic Adenocarcinoma

  Takeru Yamaguchi, Yoshihiko Kadowaki, Takeshi Okino, Eriko Uehara, Mika Ohmori, Takeki Mori

  Lead, Ovid Technologies (Wolters Kluwer Health), Aug. 2019, ACG Case Reports Journal, 6(8) (8), e00147 - e00147, English

  [Refereed]

  Scientific journal

• 臨床画像2025年4月号

  山口尊, 西内健太郎, 祖父江慶太郎

  Contributor, 肝・胆・膵−見落としやすい病変−, メジカルビュー社, Mar. 2025


• CT診断一問一答: 研修医が最初の1か月で知るべき基礎知識

  山口尊, 上野嘉子

  Contributor, 上腹部, Gakken, Sep. 2023, Japanese, ISBN: 4055200536


• 画像診断2022年増刊号Vol.42 No.11: 画像でみかける偶発的所見のマネジメント2022-あなたならどう書く?

  山口尊, 祖父江慶太郎

  Contributor, 肝の嚢胞性病変, 学研プラス, Sep. 2022, ISBN: 4780904552


• Innervision

  Takeru Yamaguchi, Keitaro Sofue, Takamichi Murakami

  Contributor, CTによる肝脂肪定量・肝線維化推定の実際と今後の展望, 株式会社インナービジョン, Apr. 2020

• Early Detection of Pancreatic Cancer on Imaging Modalities

  Takeru Yamaguchi

  MCR 2024, Jun. 2024, English

  [Invited]

  Invited oral presentation


• T1 mapping on gadoxetic acid-enhanced MR imaging as a prognostic factor in patients with pancreatic ductal adenocarcinoma

  Takeru Yamaguchi

  ECR 2024, Feb. 2024, English

  Poster presentation


• Can Gadoxetic Acid-Enhanced MRI Predict Tumor Immune Microenvironment of Hepatocellular Carcinoma?

  Takeru Yamaguchi

  ECR 2023, Mar. 2023, English

  Poster presentation


• Rim Enhancement on Contrast-Enhanced CT as a Predictor of Prognosis in Patients with Pancreatic Ductal Adenocarcinoma

  Takeru Yamaguchi

  RSNA 2022, Nov. 2022, English

  Oral presentation


• Association of Psoas Muscle Lean Volume Measured on Dual-Energy CT With Relative Dose Intensity in Patients With Hepatocellular Carcinoma Treated With Lenvatinib

  Takeru Yamaguchi

  RSNA 2020, Dec. 2020, English

  Oral presentation


• Clinical applications of Dual-energy CT for the quantitative imaging in diffuse liver diseases

  Takeru Yamaguchi

  ECR 2020, Jul. 2020, English

  Poster presentation


• Placement and Management of Central Venous Port

  Takeru Yamaguchi

  Cho Ray Hospital - JCR Radiology Symposium, 2019, English, International conference

  Public discourse


• 経カテーテル的動脈塞栓術により止血を得られた自然血気胸の2例

  山口 尊

  第65回関西IVR研究会, 2018, Japanese, Domestic conference

  Oral presentation


• 一過性脳梁膨大部病変と一過性海馬病変を伴った感染性心内膜炎の一例

  山口 尊

  第12回小児神経放射線研究会, 2017, Japanese, Domestic conference

  Oral presentation


• 腫瘍性骨軟化症を呈した鼻副鼻腔腫瘍の1例

  山口 尊

  第30回頭頸部放射線研究会, 2017, Japanese, Domestic conference

  Oral presentation


• 小脳病変を呈した低マグネシウム血症の一例

  山口 尊

  第314回日本医学放射線学会関西地方会, 2016, Japanese, Domestic conference

  Oral presentation

• Prediction of prognosis in patients with pancreatic adenocarcinoma on Gd-EOB-DTP-enhanced MRI T1 mapping

  山口 尊

  Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research, Grant-in-Aid for Early-Career Scientists, Kobe University, 01 Apr. 2020 - 31 Mar. 2023

  昨年から引き続き治療前の膵癌患者に対して，設定されたプロトコールでEOB造影MRIを撮影した.造影前および造影3分後の遅延相でT1 mapを撮像し，膵癌腫瘍内部の造影前後のT1値を定量測定するとともに，同時に他の撮像で得られる数値(T1・T2強調画像，ADC map)も測定し記録した.現在までで60例の患者に対して撮像を行った. 患者集積はやや遅れているため，今後も引き続き症例の集積を行う.予備的に症例のデータ解析を開始した.計測値より得られたT1値やT1値短縮率と病理組織学的に得られた線維性間質の多寡との間に相関関係があるかどうかをSpearmanの順位相関係数を用いて評価する.また膵癌術後や化学療法後の無病生存率ならびに全生存率を従属変数，T1値をはじめとした治療前の患者背景ならびに手術検体で得られた病理学的所見(TMN分類，癌遺残の有無)を独立変数とした多変量解析(Cox回帰比例ハザード分析)を行い，MRIにおける定量測定値と臨床的な悪性度や患者予後との関連性を検証する.今後，さらなる解析として，膵癌の線維性間質の増生に関与する活性化膵星細胞や，活性化に関与するTGF-β，PDGF，FGFなどの増殖因子とT1 mapで得られる画像解析結果との関連性を検証する.