Synapse vincent software program

CT examinations were performed using a 64-row multislice CT system (IQon Spectral CT, Philips Healthcare, Eindhoven, The Netherlands) and a 320-row multislice CT system (Aquilion ONE Genesis Edition, Tokyo, Japan). After the acquisition of precontrast scans, each subject was injected with a properly selected iodinated contrast agent of one of four brands (Omnipaque, GE Healthcare, Boston, MA; Optiray, Guerbet, Paris, France; Iomeron, Eisai, Tokyo, Japan; or Iopromide, Fujifilm, Tokyo, Japan), using a Dual Shot GX7 power injector (Nemoto, Tokyo, Japan). The injection dose was 600 mg of iodine per kg of body weight, and the duration was fixed at 30 seconds; hence, the injection rate depended on the patient's body weight. Triple-phasiccontrast-enhanced scans through the abdomen were performed without a bolus tracking program. Equilibrium-phase images were obtained 180 seconds after injection. The slice thickness for the contrast-enhanced images was 2 mm. The images were saved in DICOM format and transferred to an image workstation using the SYNAPSE VINCENT software program (Fujifilm).

Images of the lung tumors were taken using a 64 multislice CT (Light Speed VCT, GE Medical Systems, Milwaukee, WI,) and 16 multislice CT (Aquilion LB, Toshiba Medical Systems, Tokyo, Japan). Raw CT data were reconstructed into an axial CT image with 2.5 mm slice thicknesses according to the JCOG0201 definition.^{9 (link)} The CT image was displayed with a window level of −600 Hounsfield unit (HU) and a window width of 2000 HU as the lung image. Based on the JCOG0201 study, ground-glass opacity was defined as an area of a slight, homogenous increase in density that did not obscure any underlying vascular markings, and was considered to be tumor.^{9 (link)} The solid tumor component was defined as an area of increased opacification that completely obscured any underlying vascular markings. The diameters of the whole tumor and solid tumor component were measured by thin-slice CT using the SYNAPSE VINCENT software program (Fujifilm Medical, Tokyo, Japan). Peripheral and central types were distinguished to determine whether the tumor was located in the “no-fly zone”—2 cm around the proximal airway, as defined in the Radiation Therapy Oncology Group 0236 trial.^{10 (link)} Measurements of tumor diameter and tumor location were determined from the CT data without accompanying clinical data by two different radiologists.

The skeletal muscle area (SMA) [cm²], psoas muscle area (PMA) and visceral and subcutaneous fat area (VF [cm²], SF [cm²]) in addition to abdominal circumference (AC [cm]) at the 3rd lumbar level were measured from CT imaging before the induction of anti-TNF therapy, using the SYNAPSE VINCENT software program (Fuji Film, Tokyo, Japan). The skeletal muscle mass index (SMI [cm²/m²]) and psoas muscle index (PMI [cm²/m²]) was calculated as the respective muscle area divided by the square of height. The mesenteric fat mass index (MFI) was calculated as the ratio of VF to SF. SMA/SF was calculated as the ratio of SMA to SF.