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1.

論文(リポジトリ)

論文(リポジトリ)
小田, 純一
出版情報: 新潟医学会雑誌 — 新潟医学会雑誌.  109  pp.315-319,  1995-07.  新潟医学会
本文リンク: http://hdl.handle.net/10191/42511
概要: The photofluoloscopic examination is widely used in Japan for mass screening of lung cancer. But efficacy of mass screening used this method is not sufficient for improve the survival rate of the screened population. So, recently new radiological modalities are proposed for improve the efficacy of mass screening. We tried to evaluate the effectiveness of some of these new modalities, Computed Tomography (CT) and Computed Radiography with energy subtraction method (CR-ES). We used these two new modalities to the outpatients of our department who were detected by mass screening for lung cancer in Niigata City. In the first place, we compared CT with conventional radiography (CONV). These two examinations were done to the 342 outpatients at the same day in the last four years, and 334 abnormal lesions were found out by CT. Among these lesions checked by CT, 234 lesions (70 %) were detected by CONV. As a result, we concluded that if using CT for mass screening, the detectability of abnormal lesions will be improved at least 30 % than now. Next, we compared CR-ES with CONV. These two examinations and CT were done to the 36 outpatients in a last half year, and 43 abnormal lesions were detected by CT. Thirty-one of these 43 lesions (72 %) were detected by CR-ES, and twenty-six (60 %) by CONV. So, we concluded that if using CR-ES for mass screening, the detectability will be improved about 10 % than now. 続きを見る
2.

学位論文(リポジトリ)

学位
佐藤, 良平
出版情報: pp.1-23,  2018-09-20.  新潟大学
本文リンク: http://hdl.handle.net/10191/50790
概要: 【背景・目的】膵頭十二指腸切除後の膵外分泌機能低下は,栄養障害を惹き起こす契機となる注意すべき合併症の1つである.膵外分泌機能を評価する方法としてPFD (pancreatic function diagnostant) 試験,呼気試験,糞 便中脂肪測定があげられるが,現時点で保険適応とされているのはBT-PABA (N-benzoyl-L-tyrosyl-p-aminobenzonic acid) を内服後,尿中PABA排泄率をみるPFD試験のみである.しかしながら,消化・代謝に関わる内服薬の休薬と長時間蓄尿が必要なPFD試験を頻回に繰り返すことは患者負担が大きく,膵外分泌機能を評価する簡便な方法が望まれている.近年ではMultiple- detector row CTの普及により,体積の少ない膵臓でも詳細な画像解析が可能となってきた.本研究の目的は,術前後CT画像解析による測定値が膵外分泌機能低下の指標となり得るかを明らかにすることである. 【対象・方法】2006年10月から2014年3月の間に当施設にて膵頭十二指腸切除術を施行された症例のうち,術後にPFD試験 (尿中PABA排泄率,正常範囲は>70%) を行った38例を対象とした.術前後に施行されたMultiple- detector row CTによるCT画像解析にて膵 volumetry を行い,術前膵 volume,残膵量,残膵率,主膵管径,膵前後径,膵実質厚,膵実質CT値,脾CT値を測定した.さらに,膵実質CT値と脾CT値の比をP/S比率として算出した. 【結果】全症例38例の尿中PABA排泄率の中央値は,56.5% (四分位範囲49.3-64.5) であった.この中央値を参考に,正常値を含む尿中PABA排泄率55%以上の症例を正常・軽度低下群 (20例),55%未満の症例を高度低下群 (18例) として2群に分類し,両群間にて患者背景およびCT画像解析による各測定値の比較を行った.正常・軽度低下群および高度低下群の尿中PABA排泄率の中央値は,各々64.4% (四分位範囲59.3-67.2) および48.6% (四分位範囲38.6-52.4) であった.両群間で悪性疾患および通常型膵癌の割合に有意差はなかったが,高度低下群において年齢が有意に低く (P=0.030),術後補助化学療法ありの症例割合が有意に高かった (P=0.004).また,CT画像解析測定値では,残膵量 (P=0.019),残膵率 (P=0.002),術後P/S比率 (P=0.015) の値が高度低下群で有意に低値であった.年齢,通常型膵癌,術後補助化学療法あり,術後膵実質厚,残膵量,残膵率,術後P/S比率の7項目において,ロジスティック回帰分析によって解析を行った結果,膵外分泌機能高度低下群に入ることに有意に独立して寄与する項目は,術後補助化学療法あり (オッズ比9.8,P=0.043),残膵率33%未満 (オッズ比13.5,P=0.027),術後P/S比率70%未満 (オッズ比19.6,P=0.015) であった.<br />【考察】膵外分泌機能正常・軽度低下群と高度低下群の両群間において悪性疾患および通常型膵癌の割合では有意差がなく,尿中PABA排泄率低下は術後補助化学療法自体の影響がある可能性が考えられた.さらに術後補助化学療法あり,残膵率,術後P/S比率は独立して膵外分泌機能低下に寄与する項目であると考えられた.特に3次元的計測である残膵率は,膵実質厚や膵前後径に比べやや煩雑ではあるが,より正確な残膵率を反映する測定値であり,さらに術後の膵萎縮を客観的に評価する方法としても有用である.また,術後P/S比率が膵外分泌機能低下を反映するという本研究の結果は,膵実質における脂肪置換や腺房組織の変化が膵実質CT値として表現されるという過去の報告を裏付けるものとなった. 【結論】膵頭十二指腸切除後の膵外分泌機能は術後補助化学療法によって影響を受ける.また,術後CT画像解析から測定した残膵率,術後P/S比率は膵頭十二指腸切除後の膵外分泌機能低下を反映する指標となり得る.<br />学位の種類: 博士(医学). 報告番号: 乙第2226号. 学位記番号: 新大博(医)乙第1798号. 学位授与年月日: 平成30年9月20日<br />新潟医学会雑誌. 2015, 129(12), 742-750.<br />新大博(医)乙第1798号 続きを見る
3.

論文(リポジトリ)

論文(リポジトリ)
林, 孝文 ; 新国, 農 ; 斎藤, 美紀子 ; 田中, 礼 ; 平, 周三 ; 小山, 純市 ; 勝良, 剛詞 ; 西山, 秀昌
出版情報: 新潟歯学会雑誌 — 新潟歯学会雑誌.  37  pp.173-186,  2007-12.  新潟歯学会
本文リンク: http://hdl.handle.net/10191/22811
4.

論文(リポジトリ)

論文(リポジトリ)
石川, 浩志 ; Ishikawa, Hiroyuki
出版情報: 新潟医学会雑誌.  135  pp.187-192,  2021-09.  新潟医学会
本文リンク: http://hdl.handle.net/10191/0002000687
概要: CTは肺癌の画像診断において中心的な役割を担っており,過去20年ほどの間に,検出器の多列化により広範囲の薄層データ取得を可能にするとともに,逐次近似再構成法の導入により大幅な被ばく低減を実現してきた.本稿では,肺癌の画像診断におけるCTの進 歩について著者らの取り組みを交えながら解説するとともに,実用化が始まっている人工知能技術を利用したCTの画質改善や診断支援についても簡単に触れる. 続きを見る
5.

論文(リポジトリ)

論文(リポジトリ)
稲越, 英機 ; 斎藤, 真理 ; 酒井, 邦夫 ; 樋口, 健史 ; 杉田, 公 ; 北村, 達夫
出版情報: 新潟医学会雑誌 — 新潟医学会雑誌.  103  pp.75-79,  1989-02.  新潟医学会
本文リンク: http://hdl.handle.net/10191/41130
概要: A total of 62 cases of non-Hodgkin's lymphoma, treated at the Department of Radiology Niigata University Hospital from 1 980 through 1986, were analyzed. The 5-year survival rates were 62% for stage I (25 cases), 42% for stage II (18 cases), 38% for stage III (12 cases), and 45% for total. Localized lymphomas without systemic symptoms (39 cases) were treated by extended field radiotherapy combined with chemotherapy in selected cases. The frequency of relapse in this series was lower than in the era of involved field irradiation alone. CT examination was useful for detection of mass-forming abdominal desease. However, number of patients with limited upper abdominal lymphnode invasion, which was lymphographically negative and depicted only by CT, were only four. 続きを見る
6.

論文(リポジトリ)

論文(リポジトリ)
尾崎, 俊彦
出版情報: 新潟医学会雑誌 — 新潟医学会雑誌.  102  pp.273-282,  1988-05.  新潟医学会
本文リンク: http://hdl.handle.net/10191/40763
概要: Recent advances of various body imaging apparatus and development of sensitive assay system for AFP enable us to make early detection of small hepatocellular carcinoma. (sHCC). To establish more logical screening method of sHCC, diagnostic accuracy and reliability of each imaging system in 29 sHCCs (Hepatocellular carcinoma under 3 cm in diameter) was evaluated in comparison with clinico-pathological features. Sensitivities of each imaging apparatus in detection of sHCC were 57% by radionucleotide scanning (RI), 76% by ultrasonography (US), 83% by computed tomography (CT), and 85% by celiac angiography (CA), respectively. Image finding characteristic to sHCC was solid and low echoic lesion by US, serial disapperance of visualized lesion by dynamic CT, and faint diffuse staining of the lesion by CA. Small lesions around 2cm in diameter could be detected by collaborative assessment by US, CT and CA. There existed no specific risk factor to develop SHCC. Serum AFP level of 17% of sHCC remained within normal range. These data suggests the importance of periodical screening, in high risk group for liver cancer, by integrated body imaging systern in early diagnosis of sHCC. Author emphasizes the benefit of US for sHCC screening because of noninvasive and easy available method. 続きを見る
7.

学位論文(リポジトリ)

学位
Takamura, Masaki ; 髙村, 真貴
本文リンク: http://hdl.handle.net/10191/0002000381
概要: Objectives In 2017, depth (Depth of invasion: DOI) was introduced in the TNM classification of the 8th edition of the Un ion of International Cancer Control (UICC) and the 8th edition of the American Joint Committee on Cancer (AJCC). Histopathologically, DOI is defined as the vertical distance from the virtual plane connecting the basement membrane of the normal mucosa adjacent to the tumor to the deepest part of the tumor; however, there is no diagnostic imaging method for measuring DOI (image DOI). This study aimed to clarify the accuracy of intraoral ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) in preoperative image DOI measurement of T1/T2 tongue cancer through comparison with histopathological measurements. Methods Imaging of the primary lesions was performed by US, CT, and MRI at Niigata University Medical and Dental Hospital, and the lesions were classed into T1 and T2 based on the 8th edition of the AJCC/UICC, and surgery performed. There was histopathological confirmation of lesions as squamous cell carcinoma in 48 patients with tongue cancer. Cases classified as T3 and T4, cases in which preoperative chemotherapy and radiation therapy were performed, and cases where biopsy was performed before imaging were excluded. For preoperative image DOI measurements, the distance from the virtual line connecting the basal portion of the normal mucosa to the deepest portion of the tumor was determined by US. With CT and MRI, the measurement was from the virtual straight or curved line connecting the boundary between the tumor and the normal mucosa to the deepest part of the tumor. The measurement was performed using the axial image and coronal image after imaging for CT and using the axial image and coronal image by fat-suppressed T1-weighted and fat-suppressed T2-weighted imaging for MRI. For US, scanning was performed at a cross section close to the axial section, and the tumor depicted in the low echo was measured on a still image in the cross section that is depicted as the thickest. The image DOI in US, CT, and MRI and the histopathological DOI as base were comparatively investigated and statistical analyses were performed by Bland-Altman analysis and Spearman's rank correlation coefficient. Results Histopathologically, the minimum and maximum DOI were 0 mm and 10 mm, respectively, with a mean of 3.3 mm. Bland-Altman analysis showed that the US image DOI was overestimated by an average of 0.2 mm compared to the histopathological DOI, while CT and MRI image DOI were overestimated by an average of 2-3 mm. The comparison of CT and MRI revealed that the difference between the MRI and histopathological DOI, as well as the 95% limit of agreement, were smaller than those of the CT image DOI. The comparison of the T1-weighted and T2-weighted images after MRI imaging revealed that the lesions were overestimated with the T2-enhanced images. Spearman's rank correlation coefficient was greater in the order of US, MRI, and CT. Conclusions With regard to DOI measurement by preoperative diagnostic imaging of T1 and T2 squamous cell carcinoma, based on the findings from the comparison with the histopathological DOI, US is the most accurate measurement method. With CT and MRI, there tends to be overestimation of about 2 to 3 mm and so caution is required.<br />Oral Radiology. 2021.<br />新大院博(歯)第493号 続きを見る
8.

論文(リポジトリ)

論文(リポジトリ)
上松, 晃也 ; Uematsu, Kohya ; 児玉, 泰光 ; Kodama, Yasumitsu ; 勝見, 祐二 ; Katsumi, Yuji ; 木口, 哲郎 ; Kiguchi, Tetsuo ; 西川, 敦 ; Nishikawa, Atsushi ; 高木, 律男 ; Takagi, Ritsuo
出版情報: 新潟歯学会雑誌.  45  pp.73-80,  2015-12.  新潟歯学会
本文リンク: http://hdl.handle.net/10191/0002000537
概要: Background: The aim of this study was to create intelligence sharing of the current situations of mandibular third molar extraction (MTMext.) between our department and other medical institutions. Methods: Data of 599 MTMext. teeth in 461 patients who visited our department in 2014 were studied for 1) patient information, 2) X-ray images (panoramic radio graph [PRG],computed tomography [CT]), 3) procedures, and 4) post-operative complications. Results: 1) The 461 patients comprised of 198 males and 263 females. The ratio of referral patients was nearly 93%, of which 73% were referred from dentists in the general practice. 2) Pre-operative diagnosis was mainly performed based on PRG findings. Based on Winter's classification, there were 305 horizontal teeth, 165 mesio-angular teeth, and 118 vertical teeth. When based on Pell-Gregory's classification, there were 242 IA teeth, 120 IIA teeth, and 107 IB teeth. As for apex position, there were 258 Ap1 teeth, 185 Ap0 teeth, and 94 Ap2-s teeth represented. CT was taken in 185 of teeth. Bone wall of mandibular canals were seen disappeared at a high frequency in Ap2-s, Ap2-d and Ap3 teeth. 3) 514 teeth were operated in the outpatient operating room whereas 85 teeth were operated in the central operating room. Out of the total teeth, 82 teeth were operated under general anesthesia, 27 teeth with intravenous sedation and 490 teeth were operated under local anesthesia. 4) A total of 6 nerve injuries were found. In addition, surgical site infections occurred in 11 teeth. Conclusions: These findings might be useful in informing patients about MTMext. procedures and could further help practicing dentists to refer patients to specialized institutions.<br />下顎智歯抜歯は口腔外科において頻度の高い処置である。個々の症例で難易度や合併症リスクが異なるため,体制の整った施設での加療が望ましい症例も多い。今回,紹介医との情報共有を目的に当科における現況を調査した。対象は2014年に施術した下顎智歯抜歯461例599歯とし,1.患者基本情報,2.画像情報,3.手術情報,4.術後合併症に関して調査した。1.性別では男性198例246歯,女性263例353歯,平均年齢は30.5±12.6歳であった。紹介率は92.9%であり,開業歯科医院からの紹介は全体の7割を超えた。2.Winter分類は,水平305歯,近心165歯,垂直118歯,Pell-Gregory分類は,IA:242歯,ⅡA:120歯,IB:107歯,apex positionはAp1:258歯,Ap0:185歯,Ap2-s:94歯の順で多かった。CT撮影は185歯(30.8%)で追加的に実施され,Ap2-s以上でその割合が急増していた。3.施術場所は,514歯が外来手術室,85歯が中央手術室であり,麻酔別では,全身麻酔82歯,静脈内鎮静法27歯,局所麻酔単独490歯であった。全身麻酔の選択理由は外科的侵襲の大きさや両側同時抜歯が最も多く,静脈内鎮静法の選択理由は手術に対する不安(歯科恐怖症を含む)が最も多かった。4.知覚異常は6歯(1.0%)で認められた。本調査結果を紹介医と共有し,患者説明や紹介の判断基準として有効に活用されれば,今後の地域における病診連携の拡大にもつながることが期待される。 続きを見る
9.

論文(リポジトリ)

論文(リポジトリ)
蛭間, 有紀子 ; 山内, 春夫
出版情報: 新潟医学会雑誌 — 新潟医学会雑誌.  128  pp.515-530,  2014-10.  新潟医学会
本文リンク: http://hdl.handle.net/10191/43958
概要: 法医学分野における個人識別は, 身元不明死体の身元確認の為に行われることが多く, 該当者の検索と, 該当者と死体との様々な身体特徴を一対一で比較し, 同一人か否かを判定する異同識別の2つのプロセスがある. 前頭洞の形態比較は腐敗など死後変化 の影響を受けにくい骨構造を利用した個人識別の一法で, 様々な手法が提唱されている. 該当者の生前資料として提供されることが多い5mmスライス厚の頭部CT画像は, 前頭洞の形態を十分に観察できず, 前頭洞の形態比較を用いた個人識別にあまり活用されていなかった. そこで5mmスライス厚の頭部CTを画像処理し単純X線写真様のRaySum像にしてから前頭洞の形態を比較することで, 個人識別に活用できるかを検証する目的で本研究を行った. 具体的には105症例の2mmスライス厚の死後頭部CT画像と5mmスライス厚の生前頭部CT画像から作成した2種類のRaySum像について, それぞれ左右前頭洞の面積, 幅, 頂点位置, 眼窩間距離を計測した. これから眼窩間距離で補正した右前頭洞面積(R), 左前頭洞面積(L), 左右前頭洞面積合計(S)と幅(W), 頂点位置(T)を算出し, 同一人の2種類の画像の計測値差を求めた. 各パラメーターについて, この計測値差が許容範囲内であれば同一人の可能性がある該当者とする該当者検索法を考案し, 様々な計測値差の許容範囲を設定したときの検索法の感度や特異度を計算した. 検索に用いる計測値差の許容範囲をE(Rの計測値差, Lの計測値差, Sの計測値差, Wの計測値差, Tの計測値差)としたとき, E(0.30, 0.30, 0.30, 0.30, 0.30)の条件で検索法を利用すると, 感度は86.7%, 特異度は93.0%であり, 105症例のうち, 66症例は該当者が10人以下に絞り込まれた. 頭部CTのRaySum像を利用し5種類のパラメーターを比較する該当者検索法は, 該当者の絞り込みに有用であることが示された. この検索法の他にも, 例えば片側の前頭洞が欠損している, 前頭洞が非常に大きいなど, 稀な形態の症例は, その特徴を絞り込みに利用できる可能性がある. また絞り込まれた該当者についてRaySum像同士の比較で異同識別を行える可能性があり, 5mmスライス厚の頭部CT画像も, RaySum像を用いて前頭洞の形態比較をすることで, 個人識別に有効に活用できることが示された. 続きを見る
10.

論文(リポジトリ)

論文(リポジトリ)
Furusawa, Tetsuya
出版情報: Acta medica et biologica — Acta medica et biologica.  46  pp.25-33,  1998-03.  Niigata University School of Medicine
本文リンク: http://hdl.handle.net/10191/33075
概要: To determine the computed tomography (CT) and magnetic resonance (MR) characteristics of pineal region germinomas, the author reviewed images from 40 patients with pineal region tumors. These tumors were divided into two groups: those with germinomas (n =17), and those with other tumors in the pineal region (5 with a germ cell tumor other than germinoma; 8, mixed germ cell tumor; 8, pineal parenchymal tumor; and 2, miscellaneous tumors; n = 23). All cases were investigated with CT; 31 of the cases were also investigated with MR imaging. The following parameters comprised statistically significant differences between the two groups: maximum size of the tumor, tumor density of the precontrast CT, signal intensity of precontrast T1-weighted spin-echo images, and homogeneity of the tumor on both precontrast and postcontrast studies. This study found that extension patterns of pineal region tumors into the thalamus have significant implications in differentiating germinomas from other tumors of this region. Germinomas are characterized by thalamic extension without lateral displacement of the third ventricle walls due to direct compression by tumors (P =.0034). The analysis of tumor extension patterns, combined with the parameters mentioned above, may provide a more accurate differential diagnosis in pineal region tumors, leading to prompt and appropriate treatment. 続きを見る