| Project/Area Number |
19K09824
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Multi-year Fund |
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| Section | 一般 |
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| Review Section |
Basic Section 56040:Obstetrics and gynecology-related
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| Research Institution | Kanmon medical center (2021)
Yamaguchi University (2019-2020) |
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Principal Investigator |
Okada Munemasa 独立行政法人国立病院機構関門医療センター(臨床研究部), 放射線科, 生活習慣病対策研究室長 (70380003)
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| Co-Investigator(Kenkyū-buntansha) |
伊東 克能 山口大学, 大学院医学系研究科, 教授 (00274168)
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| Project Period (FY) |
2019-04-01 – 2022-03-31
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| Project Status |
Completed (Fiscal Year 2021)
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| Budget Amount *help |
¥4,290,000 (Direct Cost: ¥3,300,000、Indirect Cost: ¥990,000)
Fiscal Year 2021: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000)
Fiscal Year 2020: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000)
Fiscal Year 2019: ¥2,340,000 (Direct Cost: ¥1,800,000、Indirect Cost: ¥540,000)
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| Keywords | postpartum dyspnea / amniotic fluid embolism / dual-energy CT / lung iodine mapping / dual energy CT / 羊水塞栓 / 産後呼吸困難 / 肺血栓塞栓症 / 羊水塞栓症 / 妊娠中毒症 / 呼吸困難 / CT / 肺血栓塞栓 / 妊娠 |
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| Outline of Research at the Start |
周産期で呼吸困難を来した症例と、同一年齢の深部静脈血栓症が疑われた女性のdual energy CT (DECT)画像を比較検討することで、今まで画像診断不可能であった、希な羊水塞栓症がDECTを用いることで画像診断可能か検討し、通常の肺血栓塞栓症と異なる新たな画像診断法を確立することで、周産期死亡率の減少に寄与する。
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| Outline of Final Research Achievements |
Dual-energy computed tomography (DECT) images of acute postpartum dyspnea were compared in women with suspected pulmonary thromboembolism (PTE). A total of 86 patients were divided into 3 groups (postpartum: AFE group, PTE group and non-PTE group). Quantitation was applied to a decreased lung iodine map value (LIM5; defined as <5 HU) and the relative value of LIM5 to whole LIM volume (%LIM5). LIM defects were classified into five patterns (0: none, 1: wedge-shaped, 2: reticular/liner, 3: diffuse granular/patchy, 4: massive defects) based on a consensus between two readers. The chi-squared tests and Kruskal-Wallis/Mann-Whitney U test were used, and p values of <0.05 were considered to indicate statistical significance.
The LIM5 and %LIM5 were largest in the PTE group, and postpartum women showed intermediate values between the non-PTE and PTE groups. Wedge-shaped defects were prominent in the PTE group, and diffuse granular/patchy defect was a typical features in the postpartum group.
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| Academic Significance and Societal Importance of the Research Achievements |
産後早期に出現する妊婦の呼吸困難例では、肺血栓塞栓症(PTE)に伴うものもあるが、DECTを用いることでgranular/patchyなLIM欠損として認められる。妊婦にもPTE例がある一定程度認められるが、DECTを用いたLIM画像ではgranular/patchyな欠損としてみとめられる。これらの患者では、造影CTで肺動脈内血栓がないことから、肺胞レベルでの小さな血管閉塞(microvascular obstruction)やvasoconstrictionを見ている可能性がある。
羊水塞栓子は、妊婦の血管内に存在しているとされ、DECTは産後呼吸困難の研究に応用可能と思われる。
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