左肺上葉切除後の肺静脈断端血栓の原因となる血行動態の特徴 : 4D flow MRIを用いた研究

• Material Type: 博士論文
• Title: 左肺上葉切除後の肺静脈断端血栓の原因となる血行動態の特徴 : 4D flow MRIを用いた研究
• Author/Editor: 梅原, 正
• Author Heading: 梅原, 正 ウメハラ, タダシ
• Publication, Distribution, etc.: AME Publishing Company
• Alternative Title: Hemodynamic features underlying pulmonary vein stump thrombus formation after left upper lobectomy: Four-dimensional flow magnetic resonance imaging study
• Degree grantor/type: 鹿児島大学
• Date Granted: 2022-03-11
• Dissertation Number: 甲総研第654号
• Degree Type: 博士(医学); Doctor of Philosophy in Medical Science
• Text Language Code: eng
• Subject Heading: Pulmonary vein stump thrombus; four-dimensional flow magnetic resonance imaging (4D MRI); left upper lobectomy (LUL); lung cancer
• Target Audience: 一般
• Note (General): 博士論文全文, 博士論文要旨, 最終試験結果の要旨, 論文審査の要旨; Background: We previously reported that to-and-fro blood movement near the pulmonary vein stump was particularly prominent after left upper lobectomy compared with other lobectomy, which may be the cause of the high susceptibility of pulmonary vein thrombus after left upper lobectomy. The aim of the present study was to compare the hemodynamics in patients who developed pulmonary vein thrombus after left upper lobectomy with those in patients who did not develop pulmonary vein thrombus using four-dimensional flow magnetic resonance imaging (4D MRI). Methods: This was a retrospective evaluation of a prospectively collected clinical and radiological database of 37 patients who underwent 4D MRI 7 days after left upper lobectomy for lung cancer (n=37). We obtained two parameters by 4D MRI: the grade of to-and-fro blood movement and the flow energy loss around the pulmonary vein stump. The length of the pulmonary vein stump, a known risk factor for pulmonary vein thrombus, was also measured. Results: According to a scatterplot of the grade of to-and-fro blood movement versus the flow energy loss, patients with pulmonary vein thrombus (n=15) were concentrated in an area which appears to be a ‘dangerous’ hemodynamic condition. There were few patients without pulmonary vein thrombus in this ‘dangerous’ area, except for one who unfortunately developed delayed pulmonary vein thrombus and cerebral infarction. We proposed a formula using the 4D MRI-derived parameters based on a stepwise multiple regression analysis that was more closely associated with the development of pulmonary vein thrombus than the length of the pulmonary vein stump (area under the receiver operating characteristics curve: 0.918 vs. 0.705, P=0.0500). Conclusions: We proposed the existence of a ‘dangerous’ hemodynamic condition responsible for pulmonary vein thrombus formation. 4D MRI before the development of pulmonary vein thrombus may help identify patients requiring preventive therapy against pulmonary vein thrombus and subsequent thromboembolic complications. Tadashi Umehara, Koji Takumi, Kazuhiro Ueda, Takuya Tokunaga, Aya Harada-Takeda, Masami Sato Hemodynamic features underlying pulmonary vein stump thrombus formation after left upper lobectomy: four-dimensional flow magnetic resonance imaging study Quantitative Imaging in Medicine and Surgery 2022;12(2):992-1003 https://dx.doi.org/10.21037/qims-21-472
• Format (IMT): application/pdf
• Access Restrictions: インターネット公開
• Data Provider (Database): 国立情報学研究所 : 学術機関リポジトリデータベース（IRDB）（機関リポジトリ）; https://irdb.nii.ac.jp
• Original Data Provider (Database): 鹿児島大学 : 鹿児島大学リポジトリ

Table of Contents

Result_Umehara_Tadashi_isk_654 other

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Diss_梅原_正_ISK654_2021 fulltext

Abstract_梅原_正_4519810070_2021 abstract