Annual Report 2020
Department of Diagnostic Radiology
Masahiko Kusumoto, Miyuki Sone, Yasunori Mizuguchi, Gen Iinuma, Nachiko Uchiyama, Hirokazu Watanabe, Mototaka Miyake, Shunsuke Sugawara, Kimiteru Ito, Yuko Kubo, Chihiro Ito, Miyako Morooka, Takahiro Morita, Nao Kikkawa, Shintaro Kimura, Yuta Maruki, Sawako Kaku, Junji Omori, Mizuki Ozawa, Yuji Koretsune
Introduction
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.
Table 1. Number of Examinations per Modality
The Team and What We Do
In 2020, a total of 17 board-certified radiologists, two physicians and one ultrasound physician performed routine radiological diagnosis including IR procedures. We provided more than 88,000 radiological diagnoses, the details of which are shown in Table 1. A total of 6,470 IR procedures were performed from April 2020 to March 2021 at the center (Table 2). Furthermore, we had several consultation phone calls regarding indications for various IR procedures from all over the country.
Table 2. Type of Percutaneous Interventional Radiology Procedure
Research activities
The CT colonography (CTC) has been successfully introduced as an effective option for preoperative staging and colorectal screening in our center. Approximately 1,000 patients and/or candidates were examined using this modality in 2020. 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. Moreover, we are now developing computer-aided detection (CAD) for colorectal lesions, especially for flat lesions. The major 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, and 64Cu-ATSM PET/CT imaging has been investigated for cancer patients to improve the sensitivity and specificity of detecting tumor sites or tumor characteristics for treatment. 18F-FDG PET allows us to calculate the glucose metabolic rate of the tumor site and to predict the treatment response in patients treated with immune checkpoint inhibitors. 64Cu-ATSM PET/CT has been performed on more than 10 patients with brain tumor through the clinical research. PET/MRI has been applied to more than 900 cases of cancer patients per year and proved itself to be a powerful tool for managing malignancy. For cancer treatment using radioisotope, internal radiotherapy was conducted using radioactive iodine (I-131) chloride, Zevalin, and Xofigo. New drugs Lu-177 oxodotreotide for neuroendocrine tumor and I-131 MIBG therapy to pheochromocytoma will start by the next year.
According to 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 2021, 4,864 patients were examined. Regarding image acquisition systems, a new software-based scatter correction enabling gridless imaging has been developed and acquired in clinical usage. Furthermore, 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 the number of images for diagnosis.
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 "Public/Private R&D Investment Strategic Expansion PrograM (PRISM)", for the development of artificial intelligence to accelerate the creation of new drugs, we provided 2,000 chest CT images and diagnostic reports to construct an integrated database for lung cancer treatment. We have also developed an annotation tool for radiological images to efficiently develop deep learning models.
A major departmental research theme is establishing an evidence base for interventional radiology (IR). We have conducted multi-institutional clinical trials as a steering organization as mentioned hereunder. The in-house research topics include: feasibility and efficacy of percutaneous needle biopsy for peritoneal mass, percutaneous gastrostomy for patients undergoing partial gastrectomy, and craniocaudal access to the superior sulcus lesions of the thorax. We have also developed novel IR techniques and software, including palliative stent placement for patients with multiple bowel obstruction, lymphatic embolization using a balloon, and navigation system for vascular embolization and tumor ablation. We have explored 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, diagnostic accuracy of invasion to the pancreatic neural plexus in patients with pancreatic cancer, and simulation of IR procedures using U-HRCT data. In addition, we have started developing radiomics and artificial intelligence for the detection and characterization of pancreatic tumor.
Clinical trials
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 107 participating domestic institutions. A total of 29 studies had been completed and 22 were published. Currently, 3 clinical trials are ongoing.
Education
The clinical education and training of young radiologists is an important part of our department’s activities. We have provided educational opportunities for domestic and overseas physicians. Due to the pandemic in 2020, in-person training for overseas trainees was precluded; however, we have continued online clinical conferences with Singapore General Hospital (Singapore), Institut Gustave Roussy (France) and Dotter Institute (United States of America).
Future Prospects
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 a biomarker for personalized cancer treatments such as molecular-targeted agents, immunotherapy, and boron neutron capture therapy.
The Interventional Radiology Center started extension to create additional IR suites and a recovery room to facilitate improved access to oncologic interventions and better patient experiences. The center will be continuously aimed at (i) providing high-quality/high-speed clinical care with IR and 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 accessibility of IR in the oncology field in Japan. Furthermore, we will collaborate on the MIRAI (Minimally-Invasive Revolutionary treatments with Advanced Intelligence) project in NCCH to develop innovative medical equipment and device.
List of papers published in 2020
Journal
1. Arai Y. Interventional Radiology for Whom. Cardiovasc Intervent Radiol, 44:633-634, 2021
2. Morita S, Sugawara S, Suda T, Prasetyo D, Hoshi T, Abe S, Yagi K, Terai S. Transcatheter Arterial Embolization Using Microspheres for Palliating Pain from Bone Metastasis in a Patient with Cholangiocellular Carcinoma. Intern Med, 60:241-246, 2021
3. Kitajima K, Miyoshi Y, Sekine T, Takei H, Ito K, Suto A, Kaida H, Ishii K, Daisaki H, Yamakado K. Harmonized pretreatment quantitative volume-based FDG-PET/CT parameters for prognosis of stage I-III breast cancer: Multicenter study. Oncotarget, 12:95-105, 2021
4. Onishi Y, Ito K, Motoi N, Morita T, Watanabe SI, Kusumoto M. Ciliated muconodular papillary tumor of the lung: 18F-FDG PET/CT findings of 15 cases. Ann Nucl Med, 34:448-452, 2020
5. Onishi Y, Kusumoto M, Motoi N, Watanabe H, Watanabe SI. Ciliated Muconodular Papillary Tumor of the Lung: Thin-Section CT Findings of 16 Cases. AJR Am J Roentgenol, 214:761-765, 2020
6. Gemma A, Kusumoto M, Sakai F, Endo M, Kato T, Saito Y, Baba T, Sata M, Yamaguchi O, Yabuki Y, Nogi Y, Jinushi M, Sakamoto K, Sugeno M, Tamura R, Tokimoto T, Ohe Y. Real-World Evaluation of Factors for Interstitial Lung Disease Incidence and Radiologic Characteristics in Patients With EGFR T790M-positive NSCLC Treated With Osimertinib in Japan. J Thorac Oncol, 15:1893-1906, 2020
7. Onishi Y, Kusumoto M, Goto Y, Kaku S, Motoi N. Epithelioid hemangioendothelioma of the lung: CT findings and clinical course of 35 cases. Jpn J Clin Oncol, 50:1195-1200, 2020
8. Ohe Y, Kato T, Sakai F, Kusumoto M, Endo M, Saito Y, Baba T, Sata M, Yamaguchi O, Sakamoto K, Sugeno M, Tamura R, Tokimoto T, Shimizu W, Gemma A. Real-world use of osimertinib for epidermal growth factor receptor T790M-positive non-small cell lung cancer in Japan. Jpn J Clin Oncol, 50:909-919, 2020
9. Maehara K, Hijioka S, Nagashio Y, Ohba A, Maruki Y, Suzuki H, Sone M, Okusaka T, Saito Y. Endoscopic ultrasound-guided hepaticogastrostomy or hepaticojejunostomy without dilation using a stent with a thinner delivery system. Endosc Int Open, 8:E1034-E1038, 2020
10. Kudo M, Ueshima K, Ikeda M, Torimura T, Tanabe N, Aikata H, Izumi N, Yamasaki T, Nojiri S, Hino K, Tsumura H, Kuzuya T, Isoda N, Yasui K, Aino H, Ido A, Kawabe N, Nakao K, Wada Y, Yokosuka O, Yoshimura K, Okusaka T, Furuse J, Kokudo N, Okita K, Johnson PJ, Arai Y. Randomised, multicentre prospective trial of transarterial chemoembolisation (TACE) plus sorafenib as compared with TACE alone in patients with hepatocellular carcinoma: TACTICS trial. Gut, 69:1492-1501, 2020
11. Sugawara S, Sone M, Morita S, Hijioka S, Sakamoto Y, Kusumoto M, Arai Y. Radiologic Assessment for Endoscopic US-guided Biliary Drainage. Radiographics, 40:667-683, 2020
12. Uehara T, Yoshida H, Fukuhara M, Yoshida M, Motoi N, Sugawara S, Sone M, Arai Y, Tamura K, Uno M, Ishikawa M, Kato T. Efficacy of ascitic fluid cell block for diagnosing primary ovarian, peritoneal, and tubal cancer in patients with peritoneal carcinomatosis with ascites. Gynecol Oncol, 157:398-404, 2020
13. Kubo Y, Ito K, Sone M, Nagasawa H, Onishi Y, Umakoshi N, Hasegawa T, Akimoto T, Kusumoto M. Diagnostic Value of Model-Based Iterative Reconstruction Combined with a Metal Artifact Reduction Algorithm during CT of the Oral Cavity. AJNR Am J Neuroradiol, 41:2132-2138, 2020
14. Uchiyama N, Matsuda N, Tsugane S, Kikuchi M, Kusumoto M. Diagnostic impacts of DBT and ABVS for breast cancer screening in comparison with MMG and HUS. Proc. SPIE 11513, 15th International Workshop on Breast Imaging (IWBI2020), 115130F, 2020
15. Onishi Y, Sone M, Arai Y, Sugawara S, Kusumoto M. Transvaginal Stent as an Effective Drainage Route for Refractory Infection of a Pelvic Tumor. J Vasc Interv Radiol, 31:1886-1887, 2020
16. Sone M. Image Guidance for PICC Insertion: Commentary to "Magnetic Tracking and Electrocardiography-Guided Tip Confirmation System Versus Fluoroscopy for Placement of Peripherally Inserted Central Catheters: A Randomized, Noninferiority Comparison". Cardiovasc Intervent Radiol, 43:1898-1899, 2020
17. Sone M. Who Can Have It All? J Vasc Interv Radiol, 31:1164-1165, 2020
18. Kawakubo N, Hishiki T, Shirakawa N, Arakawa A, Sugawara S, Sone M, Arai Y, Ogawa C, Shimada K. Surgical management of intertumor abscesses caused by fistulous communications with the intestine: rare complication in pediatric malignant tumor: 2 case reports. International Journal of Surgery Oncology, 5:e98, 2020
19. Morgan R, Arabi M, Arai Y, Das M, Golzarian J, Holden A, Roy-Choudhury SH, Spiliopoulos S, Teng GJ, Tsitskari M. IR voices about COVID 19. CVIR Endovasc, 3:45, 2020
20. Tsuchiya M, Horio Y, Funazaki H, Aogi K, Miyauchi K, Arai Y, Takahashi M. Impact of gender and employment type on job loss among cancer survivors. Jpn J Clin Oncol, 50:766-771, 2020
21. Sakamoto N, Takeuchi Y, Morishita H, Arai Y. Combination Use of a Curved Tip Introducer Needle and a Straight Coaxial Needle to Facilitate an Intrahepatic Puncture During Percutaneous Transhepatic Intrahepatic Portosystemic Shunt (PTIPS). Cardiovasc Intervent Radiol, 43:803-805, 2020
22. Kawada H, Sato Y, Inaba Y, Yamaura H, Kato M, Murata S, Hasegawa T, Ogura Y, Soga N, Arai Y. Stenting Using the Rendezvous Technique for Postoperative Ureteral Complications in Cancer Patients. Cardiovasc Intervent Radiol, 43:1486-1491, 2020
23. Umakoshi N, Arai Y, Inaba Y, Sone M, Sugawara S, Itoh C, Hasegawa T, Onishi Y. Transhepatic Placement of Metallic Biliary Stent for Internal Drainage of Persistent Liver Abscesses. J Vasc Interv Radiol, 31:1000-1004, 2020
24. Sato Y, Inaba Y, Aramaki T, Sone M, Morita Y, Nishiofuku H, Tanaka T, Miyazaki M, Matsueda K, Arai Y. Hepatic Arterial Infusion Chemotherapy of 5-Fluorouracil for Patients with Unresectable Liver Metastases from Colorectal Cancer Refractory to Standard Systemic Chemotherapy: A Multicenter Retrospective Study. Oncology, 98:267-272, 2020
25. Onishi Y, Yoshioka T, Arai Y, Inaba Y, Saito H, Aramaki T, Anai H, Sone M. Randomized Controlled Study to Compare Uncovered Stent Versus Covered Stent as Percutaneous Endoprosthesis for Malignant Biliary Obstruction (JIVROSG-0207). Am J Clin Oncol, 43:784-787, 2020
26. Aramaki T, Arai Y, Takeuchi Y, Sone M, Sato R, Bekku E, Moriguchi M. A randomized, controlled trial of the efficacy of percutaneous transesophageal gastro-tubing (PTEG) as palliative care for patients with malignant bowel obstruction: the JIVROSG0805 trial. Support Care Cancer, 28:2563-2569, 2020
27. Morita S, Arai Y, Sugawara S, Sone M, Tomita K, Ishii H, Terai S. Percutaneous Gastrojejunostomy Catheter Placement Using a Slow-Leak Balloon through the Reconstructed Gastric Tube after Esophagectomy. J Vasc Interv Radiol, 31:478-481, 2020
28. Morita S, Sugawara S, Suda T, Prasetyo D, Kobayashi Y, Hoshi T, Abe S, Yagi K, Terai S. Stent Placement for Malignant Inferior Vena Cava Syndrome in a Patient with Recurrent Colon Cancer. Intern Med, 59:2885-2890, 2020
29. Murakami R, Tani H, Miki I, Yoshida T, Kumita S, Uchiyama N. Comparison between Visualization of Microcalcifications by Digital Breast Tomosynthesis and Full-Field Digital Mammography. Open Journal of Radiology, 10:90-100, 2020
30. Kitajima K, Miyoshi Y, Sekine T, Takei H, Ito K, Suto A, Kaida H, Daisaki H, Yamakado K. Harmonized pretreatment quantitative volume-based (18)F-FDG PET/CT parameters for stage IV breast cancer prognosis. Multicenter study in Japan. Hell J Nucl Med, 23:272-289, 2020
31. Inubushi M, Miura H, Kuji I, Ito K, Minamimoto R. Current status of radioligand therapy and positron-emission tomography with prostate-specific membrane antigen. Ann Nucl Med, 34:879-883, 2020
32. Nakajo M, Kitajima K, Kaida H, Morita T, Minamimoto R, Ishibashi M, Yoshiura T. The clinical value of PERCIST to predict tumour response and prognosis of patients with oesophageal cancer treated by neoadjuvant chemoradiotherapy. Clin Radiol, 75:79.e9-79.e18, 2020
33. Igaki H, Nakamura S, Kurihara H, Abe Y, Nishioka S, Fujii R, Nakamura M, Nakayama Y, Morita T, Okamoto H, Imahori Y, Itami J. Comparison of (18)FBPA uptake with (18)FDG uptake in cancer patients. Appl Radiat Isot, 157:109019, 2020
34. Kitajima K, Kaida H, Nakatani K, Ishibashi M, Morita T, Nakajo M, Tamaki Y, Minamimoto R. Assessment of tumor response to definitive chemoradiotherapy and prognosis prediction in patients with esophageal cancer judged by PET response criteria in solid tumors: multicenter study in Japan. Nucl Med Commun, 41:443-451, 2020
35. Mimura H, Akita S, Fujino A, Jinnin M, Ozaki M, Osuga K, Nakaoka H, Morii E, Kuramochi A, Aoki Y, Arai Y, Aramaki N, Inoue M, Iwashina Y, Iwanaka T, Ueno S, Umezawa A, Ozeki M, Ochi J, Kinoshita Y, Kurita M, Seike S, Takakura N, Takahashi M, Tachibana T, Chuman K, Nagata S, Narushima M, Niimi Y, Nosaka S, Nozaki T, Hashimoto K, Hayashi A, Hirakawa S, Fujikawa A, Hori Y, Matsuoka K, Mori H, Yamamoto Y, Yuzuriha S, Rikihisa N, Watanabe S, Watanabe S, Kuroda T, Sugawara S, Ishikawa K, Sasaki S. Japanese clinical practice guidelines for vascular anomalies 2017. Jpn J Radiol, 38:287-342, 2020
36. Mimura H, Akita S, Fujino A, Jinnin M, Ozaki M, Osuga K, Nakaoka H, Morii E, Kuramochi A, Aoki Y, Arai Y, Aramaki N, Inoue M, Iwashina Y, Iwanaka T, Ueno S, Umezawa A, Ozeki M, Ochi J, Kinoshita Y, Kurita M, Seike S, Takakura N, Takahashi M, Tachibana T, Chuman K, Nagata S, Narushima M, Niimi Y, Nosaka S, Nozaki T, Hashimoto K, Hayashi A, Hirakawa S, Fujikawa A, Hori Y, Matsuoka K, Mori H, Yamamoto Y, Yuzuriha S, Rikihisa N, Watanabe S, Watanabe S, Kuroda T, Sugawara S, Ishikawa K, Sasaki S. Japanese clinical practice guidelines for vascular anomalies 2017. Pediatr Int, 62:257-304, 2020
37. Mimura H, Akita S, Fujino A, Jinnin M, Ozaki M, Osuga K, Nakaoka H, Morii E, Kuramochi A, Aoki Y, Arai Y, Aramaki N, Inoue M, Iwashina Y, Iwanaka T, Ueno S, Umezawa A, Ozeki M, Ochi J, Kinoshita Y, Kurita M, Seike S, Takakura N, Takahashi M, Tachibana T, Chuman K, Nagata S, Narushima M, Niimi Y, Nosaka S, Nozaki T, Hashimoto K, Hayashi A, Hirakawa S, Fujikawa A, Hori Y, Matsuoka K, Mori H, Yamamoto Y, Yuzuriha S, Rikihisa N, Watanabe S, Watanabe S, Kuroda T, Sugawara S, Ishikawa K, Sasaki S. Japanese Clinical Practice Guidelines for Vascular Anomalies 2017. J Dermatol, 47:e138-e183, 2020
Book
1. Morita T, Fujii H. Overview of FDG PET in Oncology in Japan. In: Fujii H, Nakamura H, Yasuda S (ed), Applications of FDG PET in Oncology -Best Clinical Practice, Singapore, Springer Singapore, pp 1-21, 2020