Relationships of handgrip strength with the presence of cerebral microbleeds and platelet count in older Japanese adults.

INTRODUCTION: Lower handgrip strength is a manifestation of sarcopenia and frailty, and has been reported to be associated with cerebral microbleeds (CMBs), which appear on T2*-weighted magnetic resonance scans as low-intensity spots. However, the underlying mechanism is unknown. We hypothesized that vascular endothelial injury could be the common factor in loss of handgrip strength and CMBs. We aimed to clarify the relationship between handgrip strength and CMBs, with reference to a marker of vascular repair capability. MATERIALS AND METHODS: We conducted a cross-sectional study of 95 60- to 87-year-old Japanese people who underwent brain magnetic resonance imaging in 2016-2017. Baseline information was obtained by trained interviewers regarding the age, sex, smoking status, nutrient intake, cognition, medical history, education, and household income of the participants. Physical activity was assessed using a tri-axial accelerometer. We used the Fried frailty phenotype definition. Multivariable linear regression analysis was performed. RESULTS: Handgrip strength was independently associated with the presence of CMB after adjustment for age, sex, body mass index, classical cardiovascular risk factors, protein intake, and daily activity (B = -3.43, p = 0.027). This association was shown in participants with a low (B = -4.05, p = 0.045) but not high platelet count (B=-2.23, p = 0.479). Frailty was also independently associated with the presence of CMB after adjustment for confounders (B = 0.57, p = 0.014). Although this association was not present in participants a high platelet count, there was a positive trend in those with a low platelet count (B = 0.50, p = 0.135). CONCLUSIONS: Platelet count, a marker of vascular repair capability, appears to modify the relationship between handgrip strength and CMBs.

High resolution CT anatomy of the pulmonary fissures.

RATIONALE AND OBJECTIVES: Pulmonary interlobar fissures are important landmarks for proper identification of normal pulmonary anatomy and evaluation of disease. The purpose of this study was to define the radiologic anatomy of the pulmonary fissures using high resolution computed tomography (HRCT) in a large population. METHODS: HRCT of the lungs from aortic arch to diaphragm was performed in 622 patients, with a slice thickness of 1 mm and slice interval of 10 mm. Major, minor, and accessory fissures were studied for their orientation and completeness. RESULTS: Both major fissures were mostly facing laterally in their upper parts (100% and 89% right and left, respectively). The left major fissure faced medially (69%) while the right major fissure faced lateral (60%) in their lower parts. The right major fissure was more often incomplete (48% as compared with 43% on the left, P < 0.05). Minor fissures were convex superiorly with the apex in the anterolateral part of the base of the upper lobe, and were incomplete in 63% of cases. Azygos, inferior accessory, superior accessory, and left minor fissures were also seen in 1.2%, 8.6%, 4.6%, and 6.1% of the cases, respectively. CONCLUSION: The pulmonary fissures are highly variable and the right major fissure differs considerably from the left. The fissures are often incomplete.

Intrahepatic biloma formation (bile duct necrosis) after transcatheter arterial chemoembolization.

OBJECTIVE: The purpose of our study was to discuss the incidence, predisposing factors, and clinical course of intrahepatic biloma after transcatheter arterial chemoembolization for hepatic tumors including hepatocellular carcinoma and metastatic liver tumor. MATERIALS AND METHODS: Nine hundred seventy-two patients with hepatocellular carcinoma (n = 920) or metastatic liver tumor (n = 52) underwent chemoembolization during a 12-year period beginning in January 1989. We retrospectively reviewed the medical records and follow-up radiographs of chemoembolization and analyzed the risk factors associated with the development of intrahepatic biloma. RESULTS: Intrahepatic biloma developed after chemoembolization in 35 patients (3.6%, 35/972) in our series. The incidence of intrahepatic biloma formation in patients with metastatic liver tumor (9.6%, 5/52) was higher than that in patients with hepatocellular carcinoma (3.3%, 30/920) (p < 0.05, Fisher's exact test). The incidence of intrahepatic biloma formation in patients with hepatocellular carcinoma was statistically higher in patients with main tumor size of less than 5 cm and in those with the presence of intrahepatic bile duct dilatation. Technique-related risk factors such as injection site of drugs, repeated chemoembolization with frequency of less than 3 months, and regimen of chemoembolization significantly influenced the incidence of biloma formation in patients with hepatocellular carcinoma. No patient died of infected biloma or septicemia, but one patient died of hepatic failure 2 months after chemoembolization. CONCLUSION: Biloma formation was significantly more prevalent in the metastatic lesion group than in the hepatocellular carcinoma group. Significant prognostic factors for biloma formation in patients with hepatocellular carcinoma were tumor size of less than 5 cm, bile duct dilatation, proximal injection site, repeated injection with frequency of less than 3 months, and injection of a suspension of anticancer drugs.

Application of an artificial neural network to high-resolution CT: usefulness in differential diagnosis of diffuse lung disease.

OBJECTIVE: The purpose of our study was to evaluate the diagnostic performance of an artificial neural network (ANN) in differentiating among certain diffuse lung diseases using high-resolution CT (HRCT) and the effect of ANN output on radiologists' diagnostic performance. MATERIALS AND METHODS: We selected 130 clinical cases of diffuse lung disease. We used a single three-layer, feed-forward ANN with a back-propagation algorithm. The ANN was designed to differentiate among 11 diffuse lung diseases by using 10 clinical parameters and 23 HRCT features. Therefore, the ANN consisted of 33 input units and 11 output units. Subjective ratings for 23 HRCT features were provided independently by eight radiologists. All clinical cases were used for training and testing of the ANN by implementing a round-robin technique. In the observer test, a subset of 45 cases was selected from the database of 130 cases. HRCT images were viewed by eight radiologists first without and then with ANN output. The radiologists' performance was evaluated with receiver operating characteristic (ROC) analysis with a continuous rating scale. RESULTS: The average area under the ROC curve for ANN performance obtained with all clinical parameters and HRCT features was 0.956. The diagnostic performance of four chest radiologists and four general radiologists was increased from 0.986 to 0.992 (p = 0.071) and 0.958 and 0.971 (p < 0.001), respectively, when they used the ANN output based on their own feature ratings. CONCLUSION: The ANN can provide a useful output as a second opinion to improve general radiologists' diagnostic performance in the differential diagnosis of certain diffuse lung diseases using HRCT.