Nuclear medicine practice in Japan: a report of the eighth nationwide survey in 2017.

OBJECTIVE: Subcommittee on Survey of Nuclear Medicine Practice in Japan has performed a nationwide survey of nuclear medicine practice every 5 years since 1982 to survey contemporary nuclear medicine practice and its changes over the years. METHODS: The subcommittee sent questionnaires, including the number and category of examinations as well as the kind and dose of the radiopharmaceuticals during the 30 days of June 2017, to all nuclear medicine institutes. The total numbers for the year 2017 were then estimated. RESULTS: A total of 1132 institutes responded to the survey, including 351 PET centers. The recovery rate was 90.6%. The number of gamma cameras installed was 1332 in total, with 7.0% decrease in 5 years. Dual-head cameras and hybrid SPECT/CT scanners accounted for 88.2 and 23.6%, respectively. The number of single-photon tracer studies in 2017 was 1.08 million which means a decrease in 5.7% in 5 years and 23.6% in 10 years. All but neurotransmitter system, sentinel lymph node, and liver scintigraphy decreased. Bone scintigraphy was a leading examination (32.3%), followed by myocardial scintigraphy (24.1%) and cerebral perfusion study (18.0%) in order. SPECT studies showed an increase from 47.2% to 63.5%. PET centers have also increased from 295 to 389, as compared to the last survey. The 112 PET centers have installed one or two in-house cyclotrons. PET studies showed 24.5% increase in 5 years, with oncology accounting for 88.9%. 18F-FDG accounted for 98.2% (630,570 examinations). PET examinations using 11C-methionine have decreased, with 2440 examinations in 2017. PET examinations using 13N-NH3 have been increasing, with 2363 examinations in 2017. The number of PET studies using 11C-PIB was 904. 131I-radioiodine targeted therapies showed an increase in 5 years (23.1%), including 4487 patients for thyroid cancer. Out-patient thyroid bed ablation therapy with 1,110 MBq of 131I accounted for 36.6% of cancer patients. The number of admission rooms increased from 135 to 157 in 5 years. The number of 223Ra targeted therapies for castration-resistant metastatic prostate cancer was 1194 patients. CONCLUSIONS: Single-photon examinations showed a continuous tendency toward a decline in the survey. In contrast, the number of hybrid SPECT/CT scanner examinations has increased. PET/CT study and radionuclide targeted therapy have steadily increased.

Image Evaluation of Free-breathing Navigator Echo and Triggered Cardiac-gated Delayed Myocardial Enhancement Magnetic Resonance Imaging in Sedated Infants.

We validated a navigator-echo-triggered sequence that drives magnetization before cardiac-gated inversion recovery T1 turbo field echo acquisition, in the sedated free-breathing pediatric population. Cardiac magnetic resonance imaging was performed on sedated infants with single ventricle. We calculated the signal-to-noise ratios and contrast-to-noise ratios of 2 groups of images obtained using respiratory triggering with and without navigator echo. All images were then visually assessed by 2 observers. The signal-to-noise ratio and the contrast-to-noise ratio were significantly higher with than without navigator echo (p<0.01; p<0.05). The visual assessment scores were also consistently better with than without navigator echo (p<0.01). Free-breathing navigator echo was found to have the advantage of decreasing the motion artifact caused by respiration. Cardiacgated inversion recovery T1 turbo field echo sequence for free-breathing navigator-echo-triggered respiration allows for the acquisition, in sedated infants, of diagnostic images whose quality exceeds that of the non-navigator-echo-triggered alternative.

Verbal or Visual Memory Score and Regional Cerebral Blood Flow in Alzheimer Disease.

OBJECTIVE: Among many cognitive function deficits, memory impairment is an initial and cardinal symptom in Alzheimer disease (AD). In most cases, verbal and visual memory scores correlate highly, but in some cases the deficit of verbal or visual memory is very different from that of the other memory. In this study, we examined the neural substrates of verbal and visual memory in patients with AD. METHODS: One hundred eighty-eight consecutive patients with AD were recruited from outpatient units. Verbal and visual memory scores were evaluated using the Wechsler Memory Scale - revised. The patients underwent brain SPECT with 99mTc-ethylcysteinate dimer. RESULTS: After removing the effects of age, sex, education, and Mini-Mental State Examination scores, correlation analysis showed a significant correlation of verbal memory scores to regional cerebral blood flow (rCBF) in the bilateral cingulate gyrus and left precuneus. Similarly, a significant correlation of visual memory scores to rCBF was found in the right precuneus and right cingulate gyrus. CONCLUSION: The posterior medial cortices (PMC) are very important areas in episodic memory among patients with mild AD. Verbal memory is more closely related to the both sides of the PMC, while visual memory is more closely related to the right PMC.

Utility of second-generation single-energy metal artifact reduction in helical lung computed tomography for patients with pulmonary arteriovenous malformation after coil embolization.

PURPOSE: The quality of images acquired using single-energy metal artifact reduction (SEMAR) on helical lung computed tomography (CT) in patients with pulmonary arteriovenous malformation (PAVM) after coil embolization was retrospectively evaluated. MATERIALS AND METHODS: CT images were reconstructed with and without SEMAR. Twenty-seven lesions [20 patients (2 males, 18 females), mean age 61.2 ± 11.0 years; number of embolization coils, 9.8 ± 5.0] on contrast-enhanced CT and 18 lesions of non-enhanced lung CT concurrently performed were evaluated. Regions of interest were positioned around the coils and mean standard deviation value was compared as noise index. Two radiologists visually evaluated metallic coil artifacts using a four-point scale: 4 = minimal; 3 = mild; 2 = strong; 1 = extensive. RESULTS: Noise index was significantly improved with SEMAR versus without SEMAR (median [interquartile range]; 194.4 [161.6-211.9] Hounsfield units [HU] vs. 243.9 [220.4-286.0] HU; p < 0.001). Visual score was significantly improved with SEMAR versus without SEMAR (Reader 1, 3 [3] vs.1 [1]; Reader 2, 3 [3] vs.1 [1]; p < 0.001). Significant differences were similarly demonstrated on lung CT (p < 0.001). CONCLUSION: SEMAR provided clear chest CT images in patients who underwent PAVM coil embolization.

Evaluating Low-kV Dual-source CT Angiography by High-pitch Spiral Acquisition and Iterative Reconstruction in Pediatric Congenital Heart Disease Patients.

We retrospectively evaluated the qualities of pediatric cardiovascular dual-source computed tomography (DSCT) images reconstructed by sinogram-affirmed iterative reconstruction (SAFIRE) and filtered back projection (FBP). We analyzed the cases of 287 congenital heart disease (CHD) patients < 5 years old, referred to our department in August 2013-March 2015. We divided them into two groups according to tube voltage (70 kVp, n=147; 80 kVp, n=140). All images were acquired by a CARE kV system and reconstructed by FBP and SAFIRE. The attenuation, noise, and signal-to-noise ratio (SNR) at each region of the heart and great vessels were measured. The volume CT dose index and dose-length product values were recorded. Compared to FBP, reconstruction by SAFIRE showed that the attenuation volume was significantly lower by 0.4% except for the ascending aorta (p<0.05), the noise value was lower by about 20% (p<0.05), and the SNR was higher by approx. 25% (p<0.05). The radiation dose in the 70 kVp group was significantly lower than that in the 80 kVp group. No significant differences in SNR were observed between the patient groups. DSCT image acquisition with SAFIRE using the CARE kV system results in low image noise and radiation dose in pediatric patients with CHD.

Image Quality of Coronary Arteries on Non-electrocardiography-gated High-Pitch Dual-Source Computed Tomography in Children with Congenital Heart Disease.

This study aimed to evaluate image quality of coronary artery imaging on non-electrocardiography (ECG)-gated high-pitch dual-source computed tomography (DSCT) in children with congenital heart disease (CHD) and to assess factors affecting image quality. We retrospectively reviewed the records of 142 children with CHD who underwent non-ECG-gated high-pitch DSCT. The subjective image quality of the proximal coronary segments was graded using a five-point scale. A score <3 represented a non-diagnostic image. Age, body weight, and heart rate were compared between the two groups: patients with good diagnostic image quality in all four segments and patients with at least one segment with non-diagnostic image quality. Predictors of image quality were assessed by multivariate logistic regression, including age, body weight, and heart rate. Four-hundred-fifty-seven of the 568 segments (80.5%) had diagnostic image quality. Patients with non-diagnostic segments were significantly younger (21.6 ± 25.5 months), had lower body weight (7.82 ± 5.00 kg), and a faster heart rate (123 ± 23.7 beats/min) (each p < 0.05) than patients with diagnostic image quality in all four segments (30.6 ± 20.7 months, 10.3 ± 4.00 kg, and 113 ± 21.6 beats/min, respectively; each p < 0.05). The multivariate logistic regression revealed that body weight (odds ratio 1.228; p = 0.029) was a significant predictor of image quality. Non-ECG-gated high-pitch DSCT provided adequate image quality of the proximal coronary segments in children with CHD. Lower body weight was a factor that led to poorer image quality of the coronary arteries.

Evaluation of Urinary Stone Composition and Differentiation between Urinary Stones and Phleboliths Using Single-source Dual-energy Computed Tomography.

The aim of this study was to investigate the utility of single-source dual-energy computed tomography (SS-DECT) composition analysis in characterizing different types of urinary stones and differentiating them from phleboliths. This study included 29 patients with urinary stones who were scheduled for surgery. All patients were scanned, first using single-energy computed tomography acquisition and then DECT acquisition on SS-DECT. Dual-energy data were archived to a Gemstone spectral imaging (GSI) viewer (GE Healthcare, Milwaukee, WI, USA). Hounsfield units (HU) and effective atomic numbers (Zeff) were estimated using the GSI viewer. The results of dual-energy analysis were compared with the biochemical constitution of the stones. The chemical analysis determined that the stones included 32 calcium-based, 6 cystine and 1 struvite stone. Both HU and Zeff values were helpful in differentiating calcium-based stones from cystine and struvite stones and phleboliths. The Zeff values of phleboliths were significantly higher than those for struvite and cystine stones, whereas it was difficult to distinguish phleboliths from struvite and cystine stones using the HU values. Composition analysis using SS-DECT is helpful for distinguishing urinary stone types and discriminating phleboliths from urinary stones. Zeff values may be more useful than HU values for differentiating urinary stones from phleboliths.

Diagnostic Value of Dual-time-point F-18 FDG PET/CT and Chest CT for the Prediction of Thymic Epithelial Neoplasms.

We retrospectively assessed the dual-time-point (DTP) F-18 FDG PET/CT findings of thymic epithelial neoplasms (TENs) and investigated the diagnostic capacity of PET/CT compared to that of CT for predicting carcinoma. We calculated the ratio of the standardized uptake value of the tumor and that of the aortic arch (T/M ratio) for both the 90-min early scan and the 2-h delayed scan in 56 TEN patients. We used a multivariate logistic regression (MLR) analysis to estimate the CT features of carcinoma. We compared the diagnostic capacities of PET/CT and chest CT using receiver operating characteristic (ROC) analyses. The ROC curve revealed that the appropriate cut-off T/M ratio value for the highest accuracy was 2.39 with 75.0% accuracy. The area under the curve (AUC) was 0.855. The statistical analyses for DTP scans of 35 TEN patients demonstrated 74.3% accuracy and 0.838 AUC for the early scan versus 82.9% and 0.825 for the delayed scan. The MLR analysis indicated that mediastinal fat infiltration was a predictor of carcinoma. The ROC curve obtained for the model yielded an AUC of 0.853. Delayed scanning could improve the diagnostic capacity for carcinoma. The T/M ratio and mediastinal fat infiltration are predictive of carcinoma with moderate diagnostic accuracy.

Imaging of the temporal bone in children using low-dose 320-row area detector computed tomography.

INTRODUCTION: The aim of this study was to compare the image quality obtained using low-dose and standard-dose 320-row temporal bone computed tomography (CT) in paediatric patients. METHODS: Thirteen low-dose CT (120 kV/50 mAs) and nine standard-dose CT (120 kV/100 mAs) images from children up to 5 years of age were compared for their image quality. The noise and signal-to-noise ratio for bone, fat and air were measured. Two observers assessed the overall image quality and ability to visualize 14 small anatomic structures using a 5-point scale, with a score of 3-5 indicating imaging of diagnostic quality. RESULTS: Noise was significantly higher and the signal-to-noise ratio was significantly lower with low-dose CT. Although the overall image quality and visibility of several structures on low-dose CT were significantly reduced when compared with standard-dose CT, all the image quality scores were 3 or >3. The dose-length products for low-dose CT and standard-dose CT were 59.6 mGy·cm and 119.3 mGy·cm, respectively. CONCLUSION: Low-dose CT of the temporal bone using 320-row CT provides images of diagnostic quality for assessment of middle and inner ear anatomy, similar to that provided by the standard-dose protocol, in spite of increased image noise.

Intracoronary Cardiac Progenitor Cells in Single Ventricle Physiology: The PERSEUS (Cardiac Progenitor Cell Infusion to Treat Univentricular Heart Disease) Randomized Phase 2 Trial.

RATIONALE: Patients with single ventricle physiology are at high risk of mortality resulting from ventricular dysfunction. The preliminary results of the phase 1 trial showed that cardiosphere-derived cells (CDCs) may be effective against congenital heart failure. OBJECTIVE: To determine whether intracoronary delivery of autologous CDCs improves cardiac function in patients with single ventricle physiology. METHODS AND RESULTS: We conducted a phase 2 randomized controlled study to assign in a 1:1 ratio 41 patients who had single ventricle physiology undergoing stage 2 or 3 palliation to receive intracoronary infusion of CDCs 4 to 9 weeks after surgery or staged reconstruction alone (study A). The primary outcome measure was to assess improvement in cardiac function at 3-month follow-up. Four months after palliation, controls had an alternative option to receive late CDC infusion on request (study B). Secondary outcomes included ventricular function, heart failure status, somatic growth, and health-related quality of life after a 12-month observation. At 3 months, the absolute changes in ventricular function were significantly greater in the CDC-treated group than in the controls (+6.4% [SD, 5.5] versus +1.3% [SD, 3.7]; P=0.003). In study B, a late CDC infusion in 17 controls increased the ventricular function at 3 months compared with that at baseline (38.8% [SD, 7.7] versus 34.8% [SD, 7.4]; P<0.0001). At 1 year, overall CDC infusion was associated with improved ventricular function (41.4% [SD, 6.6] versus 35.0% [SD, 8.2]; P<0.0001) and volumes (P<0.001), somatic growth (P<0.0001) with increased trophic factors production, such as insulin-like growth factor-1 and hepatocyte growth factor, and quality of life, along with a reduced heart failure status (P<0.0001) and cardiac fibrosis (P=0.014) relative to baseline. CONCLUSIONS: Intracoronary infusion of CDCs after staged palliation favorably affected cardiac function by reverse remodeling in patients with single ventricle physiology. This impact may improve heart failure status, somatic growth, and quality of life in patients and reduce parenting stress for their families. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01829750.

Small bowel neoplasms: enhancement patterns and differentiation using post-contrast multiphasic multidetector CT.

PURPOSE: The purpose of the present study was to analyze the enhancement patterns of small bowel neoplasms on post-contrast multiphasic multidetector CT and to assess the diagnostic capacity for differentiating five tumor types. METHODS: We performed a retrospective study of data on 92 small bowel neoplasms. The neoplasms were categorized into five groups according to pathology findings, not imaging findings (23 adenocarcinomas; 22 lymphomas; 19 metastases; 18 gastrointestinal stromal tumors [GIST]; 10 neuroendocrine tumors [NET]). RESULTS: GIST and NET demonstrated a hypervascular pattern in the multiphasic dynamic study. Adenocarcinoma and lymphoma showed a delayed enhancement pattern. Metastasis was classified as an intermediate enhancement pattern. The receiver operating characteristic analyses revealed that attenuation thresholds could be set with acceptable accuracies for most of the small bowel neoplasms. CONCLUSIONS: Multiphasic dynamic studies may have the potential to improve the diagnostic capacity of multidetector CT for small bowel neoplasms.

Thallium-201 Uptake of Giant Cell Tumor: One Step Toward the Differential Diagnosis to Atypically Presenting Osteosarcoma.

OBJECTIVE: The radiologic differential diagnosis of giant cell tumors (GCTs) is challenging because there is a risk of misdiagnosis of GCTs as malignant lesions such as atypically presenting osteosarcomas (OSs). This study aims to assess the feasibility of 201Tl scintigraphy for the differential diagnosis of GCT and atypical OS. MATERIALS AND METHODS: Thallium-201 scintigraphy scans obtained between January 2006 and October 2015 of patients with histologically proven GCT (23 patients [male-to-female ratio, 15:8]; median age, 33.0 years; age range, 20-61 years) and patients with atypically presenting OS (20 patients [male-to-female ratio, 11:9]; median age, 30.0 years; age range, 12-69 years) were retrospectively reviewed. Morphologic classification of osseous lesions was performed on radiographs and CT scans. The 201Tl scintigraphy-based tumor-to-background contrast (TBC) and washout rate (WR) were calculated on early phase and delayed phase scans. The laboratory parameters lactate dehydrogenase (LDH), C-reactive protein (CRP), and alkaline phosphatase were obtained. Statistical significance was estimated using the Mann-Whitney U test. Cutoff values were calculated for early phase TBC and delayed phase TBC. RESULTS: Twenty-two of 23 GCTs were detected on the initial radiographs, whereas only six of 20 atypical OSs were detected on the initial radiographs. The early phase TBC was increased in GCT (median, 2.59; range, 0.51-12.26) compared with atypical OS (median, 1.68; range, 0.90-6.45) (p = 0.07). The delayed phase TBC was increased in GCT (median, 1.65; range, 0.22-5.26) compared with atypical OS (median, 0.96; range, 0.39-3.76) (p = 0.02). The median WR was not significantly decreased in GCT. The cutoff value for the early phase TBC was 3.90, and the cutoff value for the delayed phase TBC was 1.64; these cutoff values for early and delayed phase TBC yielded a sensitivity of 80.0% and a specificity of 47.8% and 52.2% respectively. Serum LDH (mean: atypical OS vs GCT, 215.5 vs 170.5 U/L, respectively; p = 0.01), alkaline phosphatase (median: 355.0 vs 252.0 U/L; p = 0.03), and CRP (median: 0.21 vs 0.09 mg/dL; p = 0.04) values were significantly increased in atypical OS compared with GCT. CONCLUSION: The intense 201Tl uptake of GCT in combination with laboratory OS biomarkers facilitate the differential diagnosis of GCT and atypically presenting OS.

Coronary lesion characteristics with mismatch between fractional flow reserve derived from CT and invasive catheterization in clinical practice.

High diagnostic performance of noninvasive fractional flow reserve computed from CT (FFR-CT) was recently reported in prospective multicenter trials. The aims of this study were to evaluate the diagnostic accuracy of FFR-CT in clinical practice and to examine the lesion characteristics showing a mismatch between FFR-CT and invasive FFR. A total of 20 patients (29 vessels) with suspected coronary artery disease were included. All patients underwent invasive coronary angiography and invasive FFR according to coronary artery CT angiography (CCTA) findings. The same raw data used for CCTA were used to evaluate FFR-CT. Results from FFR-CT were compared with invasively measured FFR. A positive ischemia was defined as FFR <0.80. Analyses from three vessels in two patients were not evaluated because of severe calcification or motion artifacts. The diagnostic accuracy, sensitivity, and specificity of FFR-CT per-vessel basis were 81, 100, and 69 %, respectively. To find the reason for mismatch in positive ischemia, lesion characteristics determined with CCTA were compared between the matched group and the mismatched group. A significant difference in bifurcation lesions with positive remodeling was observed between the matched group and the mismatched group (p < 0.01). The high sensitivity of FFR-CT may provide an additional support to the use of CCTA, although particular attention should be paid when using FFR-CT in bifurcation lesions with positive remodeling.

Positive affect and regional cerebral blood flow in Alzheimer's disease.

Quality of life (QOL) has been recently recognized as the central purpose of healthcare, and positive affect is one of the core dimension of QOL. However, positive affect among patients with dementia or Alzheimer's disease (AD) has not received much attention in the medical research field. One hundred sixteen consecutive patients with AD were recruited from the outpatient units of the Memory Clinic of Okayama University Hospital. The positive affect score was evaluated using the positive affect domain of the Quality of Life questionnaire for Dementia (QOL-D). Patients underwent brain SPECT with 99mTc-ethylcysteinate dimer. Positive affect scores were inversely related to apathy scores, subjective depressive scores, and delusion scores. After removing the effects of age, sex, duration of education, and cognitive function, positive affect scores showed a significant correlation with regional cerebral blood flow in the left premotor and superior frontal gyri. The left premotor and superior frontal area is significantly involved in the pathogenesis of the decrease of positive affect in AD. Apathy and depression are closely related to the prefrontal area in AD, and they may affect the relationship between positive affect and the left prefrontal area.

A Case of Focal Bone Marrow Reconversion Mimicking Bone Metastasis: The Value of 111Indium Chloride.

We present a case of a 66-year-old man with esophageal carcinoma. 18Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for evaluating distant metastasis and staging revealed 18F-FDG uptake in the third lumbar vertebra and other vertebrae. Magnetic resonance imaging could not differentiate bone metastases from benign bone lesions. We considered the possibility of bone marrow reconversion. 111Indium chloride (111In-Cl3) scintigraphy with single-photon emission computed tomography/computed tomography (SPECT/CT) revealed erythroid bone marrow components in the bone lesions. The diagnosis of bone marrow reconversion was pathologically confirmed by a bone biopsy of the third lumbar vertebra. The patient underwent esophagectomy and has remained disease-free in the 2 years since. To the best of our knowledge, this is the first report to describe the usefulness of 111In-Cl3 with SPECT/CT for the diagnosis of bone marrow reconversion.

Chronic interstitial pneumonia in young patients undergoing lung transplantation or autopsy: clinico-radiologic-pathologic observations from a single institution.

PURPOSE: To retrospectively evaluate high-resolution computed tomography (HRCT) findings and clinical diagnoses of chronic interstitial pneumonia (IP) with a poor prognosis in young patients (≤50 years). MATERIALS AND METHODS: HRCT images of 8 men and 7 women (mean age 34.8 years) obtained before lung transplantation or autopsy were reviewed. After reviewing whole lung specimens and pathologic diagnoses, all patients were clinically diagnosed according to the 2010 idiopathic pulmonary fibrosis/usual interstitial pneumonia (IPF/UIP) consensus statement. RESULTS: HRCT images revealed intralobular reticular opacity, air cysts, ground glass opacity, traction bronchiectasis, and interlobular septal thickening. Intralobular reticular opacity was the most extensive finding. Abnormal findings existed predominantly in both the peripheral and lower lung zones in only 1 patient. Classifications of HRCT patterns were "UIP" (n = 2), "inconsistent with UIP" (n = 11), and "indeterminate UIP" (n = 2). Multidisciplinary diagnoses were "IPF/UIP" (n = 1), "possible IPF/UIP" (n = 1), "IP with connective tissue disease" (n = 7), "fibrotic nonspecific IP" (n = 1), and "unclassified IP" (n = 5). CONCLUSION: The most extensive HRCT finding was intralobular reticular opacity. Most HRCT images differed from typical IPF/UIP, and IPF/UIP was uncommon in young patients with chronic IP with a poor prognosis.

Ankle muscle coactivation and its relationship with ankle joint kinematics and kinetics during gait in hemiplegic patients after stroke.

INTRODUCTION: Increased ankle muscle coactivation during gait is a compensation strategy for enhancing postural stability in patients after stroke. However, no previous studies have demonstrated that increased ankle muscle coactivation influenced ankle joint movements during gait in patients after stroke. PURPOSE: To investigate the relationship between ankle muscle coactivation and ankle joint movements in hemiplegic patients after stroke. METHODS: Seventeen patients after stroke participated. The coactivation index (CoI) at the ankle joint was calculated separately for the first and second double support (DS1 and DS2, respectively) and single support (SS) phases on the paretic and non-paretic sides during gait using surface electromyography. Simultaneously, three-dimensional motion analysis was performed to measure the peak values of the ankle joint angle, moment, and power in the sagittal plane. Ground reaction forces (GRFs) of the anterior and posterior components and centers of pressure (COPs) trajectory ranges and velocities were also measured. RESULTS: The CoI during the SS phase on the paretic side was negatively related to ankle dorsiflexion angle, ankle plantarflexion moment, ankle joint power generation, and COP velocity on the paretic side. Furthermore, the CoI during the DS2 phase on both sides was negatively related to anterior GRF amplitude on each side. CONCLUSION: Increased ankle muscle coactivation is related to decreased ankle joint movement during the SS phase on the paretic side to enhance joint stiffness and compensate for stance limb instability, which may be useful for patients who have paretic instability during the stance phase after stroke.

Exploratory analysis of textual data from the Mother and Child Handbook using the text-mining method: Relationships with maternal traits and post-partum depression.

AIM: The aim of the present study was to examine the possibility of screening apprehensive pregnant women and mothers at risk for post-partum depression from an analysis of the textual data in the Mother and Child Handbook by using the text-mining method. METHODS: Uncomplicated pregnant women (n = 58) were divided into two groups according to State-Trait Anxiety Inventory grade (high trait [group I, n = 21] and low trait [group II, n = 37]) or Edinburgh Postnatal Depression Scale score (high score [group III, n = 15] and low score [group IV, n = 43]). An exploratory analysis of the textual data from the Maternal and Child Handbook was conducted using the text-mining method with the Word Miner software program. A comparison of the 'structure elements' was made between the two groups. RESULTS: The number of structure elements extracted by separated words from text data was 20 004 and the number of structure elements with a threshold of 2 or more as an initial value was 1168. Fifteen key words related to maternal anxiety, and six key words related to post-partum depression were extracted. CONCLUSION: The text-mining method is useful for the exploratory analysis of textual data obtained from pregnant woman, and this screening method has been suggested to be useful for apprehensive pregnant women and mothers at risk for post-partum depression.

Measurement of epicardial fat thickness by transthoracic echocardiography for predicting high-risk coronary artery plaques.

Epicardial adipose tissue (EAT) volume is reported to be associated with coronary plaques. We evaluated whether non-invasive measurement of EAT thickness by echocardiography can predict high-risk coronary plaque characteristics determined independently by coronary computed tomography (CT) angiography. We enrolled 406 patients (mean age 63 years, 57 % male) referred for 64-slice CT. EAT was measured on the right ventricle free wall from a parasternal long-axis view at the end of systole. High-risk coronary plaques were defined as low-density plaques (<30 Hounsfield units) with positive remodeling (remodeling index >1.05). Patients were divided into thin or thick EAT groups using a cutoff value derived from receiver operator characteristic curve analysis for discriminating high-risk plaques. The receiver operator characteristic cutoff value was 5.8 mm with a sensitivity of 83 % and specificity of 64 % (area under the curve 0.77, 95 % confidence interval 0.70-0.83, p < 0.01). Compared with the thin EAT group, the thick EAT group had a high prevalence of low-density plaques (4 vs. 24 %, p < 0.01), positive remodeling (39 vs. 60 %, p < 0.01), and high-risk plaques (3 vs. 17 %, p < 0.01). Multiple logistic analysis revealed that thick EAT was a significant predictor of high-risk plaques (odds ratio 7.98, 95 % confidence interval 2.77-22.98, p < 0.01) after adjustment for covariates, including conventional risk factors, visceral adipose tissue area, and medications. The measurement of EAT thickness by echocardiography may provide a non-invasive option for predicting high-risk coronary plaques.

Diagnostic Performance of First-Pass Myocardial Perfusion Imaging without Stress with Computed Tomography (CT) Compared with Coronary CT Angiography Alone, with Fractional Flow Reserve as the Reference Standard.

Coronary computed tomography angiography (CCTA) in combination with first-pass CT myocardial perfusion imaging (MPI) has a better diagnostic performance than CCTA alone, compared with invasive coronary angiography as the reference standard. The aim of this study was to investigate the additional diagnostic value of first-pass CT-MPI without stress for detecting hemodynamic significance of coronary stenosis, compared with invasive fractional flow reserve (FFR). We recruited 53 patients with suspected coronary artery disease undergoing both CCTA and first-pass CT-MPI without stress and invasive FFR, and 75 vessels were analyzed. We used the same raw data for CCTA and CT-MPI. First-pass CT-MPI was reconstructed by examining the diastolic signal densities as a bull's eye map. Invasive FFR <0.8 was considered as positive. On per-vessel analysis, the area under the receiver operating characteristic curve for CCTA plus first-pass CT-MPI and CCTA alone was 0.81 (0.73-0.90) and 0.70 (0.61-0.81), respectively (P = 0.036). CCTA plus first-pass CT-MPI without stress showed 0.73 sensitivity, 0.74 specificity, 0.53 positive predictive value, and 0.87 negative predictive value for detecting hemodynamically significant coronary stenosis. First-pass CT-MPI without stress correctly reclassified 38% of CCTA false-positive vessels as true negative. First-pass CT-MPI without stress combined with CCTA demonstrated excellent diagnostic accuracy, compared with invasive FFR as the reference standard. This technique could complement CCTA for diagnosis of coronary artery disease.