Annual Report 2017

Yasuaki Arai, Yasunori Mizuguchi, Gen Iinuma, Miyuki Sone, Hiroaki Kurihara, Nachiko Uchiyama, Mari Kikuchi, Hirokazu Watanabe, Mototaka Miyake, Shunsuke Sugawara, Yuko Kubo, Chihiro Ito, Takahiro Morita, Tetsuya Hasegawa, Koji Tomita, Sayako Iwashita, Shinji Wada, Noriyuki Umakoshi, Takatoshi Kubo, Eriko Iwamoto, Shie Ogi

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.

 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. A total of 7,561 interventional radiology procedures were performed during the period from January 2017 to March 2018 at the center (Table 1). Also, we had 77 consultation phone calls regarding indications for various IR procedures from all over the country.

Table 1. Type of Percutaneous Interventional Radiology Procedure

Table 1. Type of Percutaneous Interventional Radiology Procedure

 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

Research activities

 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 2017. 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, 18F-FBPA, 11C-choline, 11C-methionine and 64Cu-DOTA-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 2018, 2807 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 algorisms such as synthetic 2D, synthetic 3D, and thick slab images have been developed and evaluated to decrease radiation dose and reading number of images.

 Image guided preoperative Breast Marking using ultrasound alone or combined with mammography has been performed for partial mastectomy cases which are difficult to determine the spread of disease. This technique makes it possible to resect abnormal lesion more precisely and assists to prevent both re-operation and local recurrence. A total of 47 cases were performed during the period from January 2017 to March 2018.

 A multicenter study to establish the CT classification of lung adenocarcinomas corresponding to the new International Association for the Study of Lung Cancer, American Thoracic Society and European Respiratory Society (IASLC/ATS/ERS) pathological classification and to build the database of small adenocarcinomas has been performed. The Digital Imaging and Communications in Medicine (DICOM) data of resected lung cancers from each institute have been accumulated and evaluated in collaboration with the Japanese Society of Thoracic Radiology.

 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.

 A major departmental research theme is establishing evidence base for interventional radiology (IR). We have performed multi-institutional clinical trials as a steering organization as mentioned hereunder. The in-house research topics presented at domestic and inter-national conferences include: percutaneous biopsy for genomic analysis using next-generation sequencer; percutaneous biopsy for mesenteric mass; percutaneous biopsy for cancer of unknown primary; percutaneous portal vein embolization prior to hepatectomy; placement of central venous ports for infants; analysis of tumor feeders using the Angio-CT system for navigating intra-arterial therapies. 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; simulation of interventional radiology procedures using the U-HRCT data.

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 99 participating domestic institutions. Five clinical trials are ongoing: a phase III study evaluating the efficacy of peritoneo-venous shunting (JIVROSG-0803); a phase III study evaluating the efficacy of percutaneous vertebroplasty for painful bone metastases (JIVROSG-0804); a phase II study evalu-ating the efficacy of arterial infusion chemotherapy and radiotherapy for unresectable maxillary carcinoma (JIVROSG-0808); a phase II trial of palliative intra-arterial epirubicin/5FU therapy for patients with chemotherapy-refractory locally-advanced or metastatic breast cancer (JIVROSG-1107); and a randomized controlled trial of selec-tive DEB-epiDOX vs. selective conventional TACE for hepatocellular carcinoma focusing on local complete response rate (JIVROSG-1302: PRESIDENT study). Also, we started developing six protocols of new clinical trials.

Education

 The clinical education and training of young radiologists is an important part of our department's activities. During 2017, six residents and one short-term resident were trained in our department. Educational opportunities for eight overseas physicians from the U.S.A., China and Singapore 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) and Institut Gustave Roussy (France) are held.

Future prospects

 The Department of Diagnostic Radiology aims to strive 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 personal ized cancer treatments such as molecular-targeted agents, immunotherapy, and boron neutron capture therapy.

 The Interventional Radiology Center will be aimed at (i) continuously providing the 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 January 2017 - March 2018

Journal

 1. Nozawa K, Tomita M, Takahashi E, Toma S, Arai Y, Takahashi M. Distress from changes in physical appearance and support through information provision in male cancer patients. Jpn J Clin Oncol, 47:720-727, 2017

 2. Kuriyama A, Umakoshi N, Sun R. Prophylactic Corticosteroids for Prevention of Postextubation Stridor and Reintubation in Adults: A Systematic Review and Meta-analysis. Chest, 151:1002-1010, 2017

 3. Hasegawa T, Ota H, Matsuura T, Seiji K, Mugikura S, Motoi F, Unno M, Takase K. Endovascular Treatment of Hepatic Artery Pseudoaneurysm after Pancreaticoduodenectomy: Risk Factors Associated with Mortality and Complications. J Vasc Interv Radiol, 28:50-59.e5, 2017

 4. Shida D, Iinuma G, Komono A, Ochiai H, Tsukamoto S, Miyake M, Kanemitsu Y. Preoperative T staging using CT colonography with multiplanar reconstruction for very low rectal cancer. BMC Cancer, 17:764, 2017

 5. Okuyama H, Ikeda M, Takahashi H, Ohno I, Hashimoto Y, Mitsunaga S, Sakamoto Y, Kondo S, Morizane C, Ueno H, Kobayashi T, Arai Y, Okusaka T. Transarterial (Chemo)Embolization for Liver Metastases in Patients with Neuroendocrine Tumors. Oncology, 92:353-359, 2017

 6. Sugawara S, Arai Y, Sone M, Katai H. Frequency, Severity, and Risk Factors for Acute Pancreatitis After Percutaneous Transhepatic Biliary Stent Placement Across the Papilla of Vater. Cardiovasc Intervent Radiol, 40:1904-1910, 2017

 7. Ikeda M, Okusaka T, Sato Y, Furuse J, Mitsunaga S, Ueno H, Morizane C, Inaba Y, Kobayashi T, Arai Y. A Phase I/II trial of continuous hepatic intra-arterial infusion of 5-fluorouracil, mitoxantrone and cisplatin for advanced hepatocellular carcinoma. Jpn J Clin Oncol, 47:512-519, 2017

 8. Makita S, Kurihara H, Tobinai K. Intravenacaval invasion of classical Hodgkin lymphoma detected with 18F-fluorodeoxyglucose (18F-FDG) PET-MRI. Lancet Oncol, 18:e233, 2017

 9. Nakagawa K, Takahashi S, Endo M, Ohde Y, Kurihara H, Terauchi T. Can 18F-FDG PET predict the grade of malignancy in thymic epithelial tumors? An evaluation of only resected tumors. Cancer management and research, 9:761-768, 2017

10. Sasada S, Kurihara H, Kinoshita T, Yoshida M, Honda N, Shimoi T, Shimomura A, Yonemori K, Shimizu C, Hamada A, Kanayama Y, Watanabe Y, Fujiwara Y, Tamura K. Visualization of HER2-specific breast cancer intratumoral heterogeneity using 64Cu-DOTA-trastuzumab PET. Eur J Nucl Med Mol Imaging, 44:2146-2147, 2017

11. Kitahara H, Maruyama D, Maeshima AM, Makita S, Miyamoto K, Fukuhara S, Munakata W, Suzuki T, Kobayashi Y, Tajima K, Terauchi T, Kurihara H, Taniguchi H, Komatsu N, Tobinai K. Prognosis of patients with peripheral T cell lymphoma who achieve complete response after CHOP/CHOP-like chemotherapy without autologous stem cell transplantation as an initial treatment. Ann Hematol, 96:411-420, 2017

12. Yasaka K, Furuta T, Kubo T, Maeda E, Katsura M, Sato J, Ohtomo K. Full and hybrid iterative reconstruction to reduce artifacts in abdominal CT for patients scanned without arm elevation. Acta Radiol, 58:1085-1093, 2017

13. Watanabe Y, Kurihara H, Itami J, Sasaki R, Arai Y, Sugimura K. Relationship between the uptake of 18F-borono-L-phenylalanine and L-[methyl-11C] methionine in head and neck tumors and normal organs. Radiat Oncol, 12:17, 2017

14. Nakanishi K, Arai Y, Sone M, Sulaiman S, Esaki M, Shimada K. Successful Percutaneous Transhepatic Removal of an Internal Plastic Stent Migrated into the Intrahepatic Bile Duct after Pancreatoduodenectomy. Interventional Radiology, 2:19-24, 2017

15. Inaba Y, Arai Y, Sone M, Aramaki T, Osuga K, Tanaka H, Kanemasa K. Experiments for the Development of a Steerable Microcatheter. Cardiovasc Intervent Radiol, 40:1921-1926, 2017

16. Kano D, Nakagami Y, Kurihara H, Hosokawa S, Zenda S, Kusumoto M, Fujii H, Kaneta T, Saito S, Uesawa Y, Kagaya H. Development of a double-stranded siRNA labelling method by using 99mTc and single photon emission computed tomography imaging. J Drug Target, 25:172-178, 2017

17. Kono Y, Kurihara H, Kawamoto H, Yasui N, Honda N, Igaki H, Itami J. Radiation absorbed dose estimates for 18F-BPA PET. Acta Radiol, 58:1094-1100, 2017

18. Umakoshi N, Gobara H, Hiraki T, Iguchi T, Fujiwara H, Sakurai J, Matsui Y, Masaoka Y, Ihara H, Wada T, Seno T, Kanazawa S. A Case of Solitary Metastasis from a Hepatocellular Carcinoma to the Sacral Bone Successfully Treated with Percutaneous Cryoablation. Interventional Radiology, 2:14-18, 2017

19. Kumamaru KK, Murayama S, Yamashita Y, Nojo T, Watanabe Y, Goto M, Maeda E, Echigo J, Soga S, Fujii S, Tanami Y, Okabe T, Okada M, Munechika J, Ota H, Miyake M, Honda H, Aoki S. Appropriate imaging utilization in Japan: a survey of accredited radiology training hospitals. Jpn J Radiol, 35:648-654, 2017

20. Shibayama Y, Namikawa K, Sone M, Takahashi A, Tsutsumida A, Sugawara S, Arai Y, Aihara Y, Suzuki S, Nakayama J, Imafuku S, Yamazaki N. Efficacy and toxicity of transarterial chemoembolization therapy using cisplatin and gelatin sponge in patients with liver metastases from uveal melanoma in an Asian population. Int J Clin Oncol, 22:577-584, 2017

21. Sasada S, Kurihara H, Kinoshita T, Yoshida M, Honda N, Shimoi T, Shimomura A, Yunokawa M, Yonemori K, Shimizu C, Hamada A, Kanayama Y, Watanabe Y, Fujiwara Y, Tamura K. 64Cu-DOTA-trastuzumab PET imaging for HER2-specific primary lesions of breast cancer. Ann Oncol, 28:2028-2029, 2017

22. Yoshii Y, Matsumoto H, Yoshimoto M, Zhang MR, Oe Y, Kurihara H, Narita Y, Jin ZH, Tsuji AB, Yoshinaga K, Fujibayashi Y, Higashi T. Multiple Administrations of 64Cu-ATSM as a Novel Therapeutic Option for Glioblastoma: a Translational Study Using Mice with Xenografts. Translational oncology, 11:24-30, 2018

23. Morita T, Kurihara H, Hiroi K, Honda N, Igaki H, Hatazawa J, Arai Y, Itami J. Dynamic changes in 18F-borono-L-phenylalanine uptake in unresectable, advanced, or recurrent squamous cell carcinoma of the head and neck and malignant melanoma during boron neutron capture therapy patient selection. Radiat Oncol, 13:4, 2018