Department of Diagnostic Radiology (Interventional Radiology Center)
Masahiko Kusumoto, Miyuki Sone, Yasunori Mizuguchi, Gen Iinuma, Hiroaki Kurihara, Nachiko Uchiyama, Hirokazu Watanabe, Shunsuke Sugawara, Kimiteru Ito, Mototaka Miyake, Yuko Kubo, Chihiro Ito, Takahiro Morita, Tetsuya Hasegawa, Yasuyuki Onishi, Shintaro Kimura, Noriyuki Umakoshi, Shinji Fujizuka, Yasuaki Arai, Shie Ogi, Mari Kikuchi, Eriko Iwamoto
The Department of Diagnostic Radiology provides a wide range of modalities, including interventional radiology (IR), general radiology, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, mammography, and nuclear medicine (Table 1).
In 2014, we launched the Interventional Radiology Center to facilitate widespread proliferation of IR in Japan and to provide various IR treatments for patients referred from other hospitals or clinics.
We seek individuals with outstanding leadership capabilities, proven academic and administrative experience, a vision to build and sustain programs at the forefront of imaging research, and a commitment to clinical experience.
Our team and what we do
In 2018, a total of 16 board-certified radiologists, one ultrasound physician and one resident cooperatively performed routine radiological diagnosis including IR procedures. We provided a total of more than 90,000 radiological diagnoses, the details of which are shown in table 1.
A total of 6,264 interventional radiology procedures were performed from April 2018 to March 2019 at the center (Table 2). Also, we had 48 consultation phone calls regarding indications for various IR procedures from all over the country.
The CT colonography (CTC) has been successfully introduced as an effective option for preoperative staging and colorectal screening in our center. Nearly 1,000 patients and/or candidates were examined with this modality in 2018. For the preparation of screening CTC, electronic cleansing with fecal barium tagging and automated CO2 gas insufflation systems have been established in formal National Cancer Center (NCC) collaboration studies with associated companies. Furthermore, we are now developing computer-aided detection (CAD) for colorectal lesions, especially for flat lesions. The main purpose of our CTC research work is to conduct a multicenter trial to establish evidence regarding fully digitalized CTC for a colorectal screening system in Japan.
A multi tracer consisting of 18F-FDG, 18FFBPA, 11C-choline, 11C-methionine and 64CuDOTA-antibody PET imaging has been studied for cancer patients to improve the sensitivity and specificity of detecting tumor sites or tumor characteristics. 18F-FDG dynamic PET sampling with Patrak-plot analysis allows us to calculate the glucose metabolic rate of the tumor site. 18F-FBPA PET/CT has been conducted in over 100 cancer patients through the clinical research. 11C-choline and 11C-methionine PET/ CT examinations have been scheduled routinely two days per week. As for 64Cu-DOTA-antibody PET imaging, 64Cu-DOTA-trastuzumab PET/ CT has been conducted in HER-2 positive breast cancer patients. Respiratory-gated PET/CT was evaluated to reduce breathing-induced artifacts using a four-dimensional PET/CT protocol. It provided better localization and quantification of tumors around the lower thorax to the upper abdomen. A newly installed scanner of PET/MRI has been applied to more than 700 cases of cancer patients and proved itself to be a powerful tool for managing malignancy. For cancer treatment, internal radiotherapy was carried out with the use of radioactive iodine (I-131) chloride, Zevalin, metastron, and Xofigo.
In accordance with the achievement of collaborative research with the associated company since 2009, digital breast tomosynthesis (DBT) has been introduced as an effective routine option for preoperative evaluation since March 2014. Up to March 2019, 3,646 patients were examined. Regarding image acquisition systems, new software-based scatter correction enabling gridless has been developed and acquired in clinical usage. In addition, new volumetric image reconstruction algorithms such as synthetic 2D, synthetic 3D, and thick slab images have been developed and evaluated to decrease radiation dose and to read the number of images.
The Japan Response Evaluation Criteria in Solid Tumors (RECIST) working group has developed a tumor response evaluation computer system compliant with DICOM data, which is capable of semiautomatic RECIST and iRECIST evaluation.
In the project of "Public/Private R&D Investment Strategic Expansion PrograM (PRISM)", for the development of artificial intelligence to accelerate the creation of new drugs, we provided 1,500 chest CT images and diagnostic reports to build an integrated database for lung cancer treatment. We have also developed an annotation tool for radiological images in order to efficiently develop deep learning models.
A major departmental research theme is establishing an evidence base for interventional radiology (IR). We have performed multiinstitutional clinical trials as a steering organization as mentioned hereunder. The inhouse research topics presented at domestic and international conferences include: costeffectiveness analysis of cryoablation versus partial nephrectomy for renal tumor less than 4cm; the safety and efficacy of percutaneous cryoablation for small renal tumors equivalent to T1a. We started investigating the efficacy of the ultra-high-resolution computed tomography (U-HRCT), which had been developed in the NCC. The research topics related to U-HRCT include: staging and evaluating the treatment efficacy of head and neck cancers; staging, defining resectability, and evaluating the treatment efficacy of biliary and pancreatic cancers; and simulation of interventional radiology procedures using the U-HRCT data.
We have led a multi-institutional cooperative study group of interventional radiology (JIVROSG: Japan Interventional Radiology in Oncology Study Group) since 2002 as a steering organization of 99 participating domestic institutions. Two clinical trials are ongoing: a phase III study evaluating the efficacy of percutaneous vertebroplasty for painful bone metastases (JIVROSG-0804) and a phase II study evaluating the efficacy of arterial infusion chemotherapy and radiotherapy for unresectable maxillary carcinoma (JIVROSG-0808). Case enrollment had been completed in two clinical trials: a phase III study evaluating the efficacy of peritoneo-venous shunting (JIVROSG-0803) and a randomized controlled trial of selective DEB-epiDOX vs. selective conventional TACE for hepatocellular carcinoma focusing on local complete response rate (JIVROSG-1302: PRESIDENT study). Also, we started developing one protocol of a new clinical trial.
The clinical education and training of young radiologists is an important part of our department's activities. During 2018, eight residents were trained in our department. Educational opportunities for some overseas physicians were also provided. We have several clinical or educational conferences. A daily clinical IR case conference, a weekly educational case conference on diagnostic radiology, a monthly IR research conference, a weekly educational conference on IR in English, and a tri-monthly international tele-conference on IR cases with Singapore General Hospital (Singapore), Institut Gustave Roussy (France) and Dotter Institute (United States of America) are held.
The Department of Diagnostic Radiology strives for excellence in clinical care, education, and research. Our goal is to provide outstanding patient-centered radiology services and to establish evidence in this area. Future challenges include promoting the active role of the Interventional Radiology Center opened in 2014 and facilitating imaging as biomarkers for personalized cancer treatments such as molecular-targeted agents, immunotherapy, and boron neutron capture therapy.
The Interventional Radiology Center will be aimed at (i) continuously providing high-quality / high-speed clinical care with IR procedures for patients both in and outside the hospital, (ii) promoting the education and training of IR procedures and clinical research for young physicians, and (iii) enhancing the usage and the accessibility of IR in the oncology field in Japan.
List of papers published in 2018
1. Ito K, Schoder H, Teng R, Humm JL, Ni A, Wolchok JD, Weber WA. Prognostic value of baseline metabolic tumor volume measured on 18F-fluorodeoxyglucose positron emission tomography/ computed tomography in melanoma patients treated with ipilimumab therapy. Eur J Nucl Med Mol Imaging, 46:930-939, 2019
2. Mehta-Shah N, Ito K, Bantilan K, Moskowitz AJ, Sauter C, Horwitz SM, Schoder H. Baseline and interim functional imaging with PET effectively risk stratifies patients with peripheral T-cell lymphoma. Blood Adv, 3時18分7-197, 2019
3. Sugawara S, Arai Y, Sone M, Ishiguchi T, Kitagawa A, Aramaki T, Sato R, Morishita H, Takeuchi Y, Inaba Y. Phase II Trial of Transarterial Embolization Using an n-Butyl-2-Cyanoacrylate/Lipiodol Mixture (JIVROSG-0802). Cardiovasc Intervent Radiol, 42:534- 541, 2019
4. Nakanishi K, Nakagawa K, Asakura K, Yoshida Y, Watanabe H, Watanabe SI. Is Calcification in the Regional Lymph Nodes a Benign Feature in Patients with Lung Cancer? World J Surg, 2019
5. Inaba Y, Arai Y, Sone M, Aramaki T, Osuga K, Tanaka H, Kanemasa K. Clinical trial for development of a steerable microcatheter. Minim Invasive Ther Allied Technol, 28:1-5, 2019
6. Takeuchi Y, Arai Y, Sone M, Sugawara S, Aramaki T, Sato R, Kichikawa K, Tanaka T, Morishita H, Ito T, Yamakado K, Baba Y, Kobayashi T. Evaluation of stent placement for vena cava syndrome: phase II trial and phase III randomized controlled trial. Support Care Cancer, 27:1081-1088, 2019
7. Onishi Y, Arai Y, Sone M, Ito C, Umakoshi N, Wada S. A Novel Technique of Urine Drainage from Bilateral Kidneys with a Single Catheter. J Vasc Interv Radiol, 30:412-413, 2019
8. Uchida S, Tsuta K, Kusumoto M, Shiraishi K, Kohno T, Watanabe SI. Radiopathologic correlation of collision lung cancer with ground-glass opacity. Asian Cardiovasc Thorac Ann, 27:45-48, 2019
9. Gemma A, Kusumoto M, Kurihara Y, Masuda N, Banno S, Endo Y, Houzawa H, Ueno N, Ohki E, Yoshimura A. Interstitial Lung Disease Onset and Its Risk Factors in Japanese Patients With ALK-Positive NSCLC After Treatment With Crizotinib. J Thorac Oncol, 14:672-682, 2019
10. Masuda N, Ohe Y, Gemma A, Kusumoto M, Yamada I, Ishii T, Yamamoto N. Safety and effectiveness of alectinib in a real-world surveillance study in patients with ALK-positive non-small-cell lung cancer in Japan. Cancer Sci, 110時14分01-1407, 2019
11. Mitsuzaki K, Iinuma G, Morimoto T, Miyake M, Tomimatsu H. Computed tomographic colonography with a reduced dose of laxative using a novel barium sulfate contrast agent in Japan. Jpn J Radiol, 37:245-254, 2019
12. Komono A, Shida D, Iinuma G, Tsukamoto S, Sakamoto R, Moritani K, Miyake M, Kanemitsu Y. Preoperative T staging of colon cancer using CT colonography with multiplanar reconstruction: new diagnostic criteria based on "bordering vessels". Int J Colorectal Dis, 34:641-648, 2019
13. Ito K, Teng R, Schoder H, Humm JL, Ni A, Michaud L, Nakajima R, Yamashita R, Wolchok JD, Weber WA. 18F-FDG PET/CT for Monitoring of Ipilimumab Therapy in Patients with Metastatic Melanoma. J Nucl Med, 60:335-341, 2019
14. Kitajima K, Nakatani K, Yamaguchi K, Nakajo M, Tani A, Ishibashi M, Hosoya K, Morita T, Kinoshita T, Kaida H, Miyoshi Y. Response to neoadjuvant chemotherapy for breast cancer judged by PERCIST - multicenter study in Japan. Eur J Nucl Med Mol Imaging, 45:1661-1671, 2018
15. Sone M, Arai Y, Sugawara S, Tomita K. Right-versus left-subclavian central venous port for patients with malignant tumor: a retrospective comparison of adverse events and imaging findings. Interventional Radiology, 3時12分1-125, 2018
16. Tanigawa N, Arai Y, Yamakado K, Aramaki T, Inaba Y, Kanazawa S, Matsui O, Miyazaki M, Kodama Y, Anai H, Hamanaka A. Phase I/ II Study of Radiofrequency Ablation for Painful Bone Metastases: Japan Interventional Radiology in Oncology Study Group 0208. Cardiovasc Intervent Radiol, 41:1043-1048, 2018
17. Tamura A, Arai Y, Sone M, Sugawara S, Ishii H, Morita S, Haraguchi T. Management of Entrapped Malecot Catheters. Interventional Radiology, 3:95, 2018
18. Koizumi J, Hara T, Sekiguchi T, Ichikawa T, Tajima H, Takenoshita N, Tanikake M, Suyama Y, Kaji T, Kato K, Sone M, Arai Y, Anai H, Kichikawa K, Fujieda H, Nishibe T, Yamada N, Nakamura M, Nakano T, Kunieda T, Kuriyama T, Sugimoto T, Takayama M, Kobayashi T, Goto S, Kanazawa M, Itou M, Shirato K. Multicenter investigation of the incidence of inferior vena cava filter fracture. Jpn J Radiol, 36:661-668, 2018
19. Hasegawa T, Seiji K, Ota H, Matsuura T, Satani N, Sato T, Takase K. Rapid Development of New Aneurysms in the Adjacent Pancreatic Arcade Arteries after Urgent Embolization of Pancreaticoduodenal Artery Aneurysms in Cases with Celiac Stenosis. J Vasc Interv Radiol, 29:1306-1308.e2, 2018
20. Umakoshi N, Arai Y, Sone M, Sugawara S. Compact coil packing using a steerable microcatheter for a giant wide-necked pulmonary artery pseudoaneurysm. Interact Cardiovasc Thorac Surg, 2018
21. Morita S, Arai Y, Sugawara S, Sone M, Sakamoto Y, Okusaka T, Yoshinaga S, Saito Y, Terai S. Antireflux Metal Stent for Initial Treatment of Malignant Distal Biliary Obstruction. Gastroenterol Res Pract, 2018時38分05173, 2018
22. Yanagawa M, Kusumoto M, Johkoh T, Noguchi M, Minami Y, Sakai F, Asamura H, Tomiyama N. Radiologic-Pathologic Correlation of Solid Portions on Thin-section CT Images in Lung Adenocarcinoma: A Multicenter Study. Clin Lung Cancer, 19:e303-e312, 2018
23. Ueda T, Aokage K, Mimaki S, Tane K, Miyoshi T, Sugano M, Kojima M, Fujii S, Kuwata T, Ochiai A, Kusumoto M, Suzuki K, Tsuchihara K, Nishikawa H, Goto K, Tsuboi M, Ishii G. Characterization of the tumor immune-microenvironment of lung adenocarcinoma associated with usual interstitial pneumonia. Lung Cancer, 126:162-169, 2018
24. Ueda T, Aokage K, Nishikawa H, Neri S, Nakamura H, Sugano M, Tane K, Miyoshi T, Kojima M, Fujii S, Kuwata T, Ochiai A, Kusumoto M, Suzuki K, Tsuboi M, Ishii G. Immunosuppressive tumor microenvironment of usual interstitial pneumonia-associated squamous cell carcinoma of the lung. J Cancer Res Clin Oncol, 144:835-844, 2018
25. Aokage K, Miyoshi T, Ishii G, Kusumoto M, Nomura S, Katsumata S, Sekihara K, Tane K, Tsuboi M. Influence of Ground Glass Opacity and the Corresponding Pathological Findings on Survival in Patients with Clinical Stage I Non-Small Cell Lung Cancer. J Thorac Oncol, 13時53分3-542, 2018
26. Toki S, Motoi T, Miyake M, Kobayashi E, Kawai A, Yoshida A. Minute mesenchymal chondrosarcoma within osteochondroma: an unexpected diagnosis confirmed by HEY1-NCOA2 fusion. Hum Pathol, 81:255-260, 2018
27. Ebata T, Shimoi T, Bun S, Miyake M, Yoshida A, Shimomura A, Noguchi E, Yonemori K, Shimizu C, Fujiwara Y, Narita Y, Tamura K. Efficacy and Safety of Pazopanib for Recurrent or Metastatic Solitary Fibrous Tumor. Oncology, 94:340-344, 2018
28. Tsukamoto S, Miyake M, Shida D, Ochiai H, Yamada K, Kanemitsu Y. Intersphincteric Resection Has Similar Long-term Oncologic Outcomes Compared With Abdominoperineal Resection for Low Rectal Cancer Without Preoperative Therapy: Results of Propensity Score Analyses. Dis Colon Rectum, 61:1035-1042, 2018
29. Hijioka S, Arai Y, Sone M, Yoshinaga S, Chan J, Sakamoto Y, Okusaka T, Saito Y. Novel forward-viewing EUS-guided ileoureterostomy technique for recurrent pyelonephritis caused by ureteral stenosis. VideoGIE, 3時28分1-283, 2018
1. Uchiyama N, Kurihara H, Kinoshita T, Yoshida M , Kikuchi M, Otsuka K, Arai Y. Preliminary Experiences of DBT (digital breast tomosynthesis) and Hybrid 18F-FDG-PET/MR (PETMR) for Neoadjuvant Chemotherapy (NAC) Cases in Breast Cancer. In: Proc SPIE 10718, 14th International Workshop on Breast Imaging, 2018