{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:53:43Z","timestamp":1790985223605,"version":"4.1.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the diagnostic performance of spectral imaging for differentiating intrapancreatic accessory spleen (IPAS) from hypervascular pancreatic neoplasms using portal-venous phase (PVP) spectral CT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This retrospective study included patients with hypervascular pancreatic lesions identified on PVP spectral CT. Lesion and splenic densities were measured on conventional images, virtual monochromatic images (VMI; 40\u2013140\u2009keV), virtual non-contrast (VNC) images, iodine maps, and effective atomic number (Z_eff) maps. Relative lesion-to-spleen ratios (RLSRs), with values closer to zero indicating greater similarity to the spleen, were compared between IPAS and neoplasms; diagnostic performance in the whole cohort and among patients with pancreatic tail lesions was assessed using the area under the receiver operating characteristic curve (AUC). For pancreatic tail lesions, three radiologists visually graded IPAS likelihood using conventional imaging alone and conventional imaging plus spectral imaging. Pooled sensitivity\/specificity\/accuracy and intraclass correlation coefficients (ICCs) were used to evaluate visual discriminative performance and inter-observer reproducibility, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighty-five patients (median age, 63.0 [IQR: 56.0\u201373.0] years; 45 men) with 34 IPAS and 51 neoplasms (34 IPAS and 22 neoplasms in the pancreatic tail) were included. RLSRs were lower in IPAS than in neoplasms across all image series (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In the whole-cohort\/pancreatic-tail subgroup, AUCs of RLSR on conventional imaging, VNC, 40-keV VMI, iodine density, and Z_eff were 0.799\/0.737, 0.835\/0.899, 0.950\/0.972, 0.960\/0.980, and 0.969\/0.992, respectively. In visual assessment, conventional plus spectral imaging improved pooled sensitivity\/specificity\/accuracy and ICC compared with conventional imaging alone (86.3%\/90.9%\/88.1% vs. 61.8%\/59.1%\/60.7%, 0.929 vs. 0.649, all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Spectral imaging may facilitate differentiation of IPAS from hypervascular pancreatic neoplasms using only portal-venous-phase CT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Can spectral imaging applied to hypervascular pancreatic lesions differentiate intrapancreatic accessory spleen (IPAS) from hypervascular neoplasms when only a single contrast-enhanced phase is available?<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Use of spectral imaging yielded higher quantitative and qualitative performance for differentiating IPAS from neoplasms than conventional imaging, with better interobserver reproducibility in visual assessment<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Evaluating spectral properties may facilitate discrimination of IPAS from hypervascular pancreatic neoplasms identified on routine portal venous phase CT that would otherwise remain indeterminate on conventional CT and require additional diagnostic procedures<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12924-7","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T07:27:42Z","timestamp":1790926062000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Spectral imaging for differentiating intrapancreatic accessory spleen from hypervascular pancreatic neoplasms using single-phase post-contrast CT"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3280-7346","authenticated-orcid":false,"given":"Yasunori","family":"Nagayama","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taihei","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soichiro","family":"Ishiuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadahiro","family":"Yamamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuaki","family":"Igarashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Kidoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seitaro","family":"Oda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Nakaura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshinori","family":"Hirai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"key":"12924_CR1","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.ijsu.2017.07.045","volume":"45","author":"J Vikse","year":"2017","unstructured":"Vikse J, Sanna B, Henry BM et al (2017) The prevalence and morphometry of an accessory spleen: a meta-analysis and systematic review of 22,487 patients. Int J Surg 45:18\u201328","journal-title":"Int J Surg"},{"key":"12924_CR2","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.1056\/NEJM198104303041822","volume":"304","author":"BM Wadham","year":"1981","unstructured":"Wadham BM, Adams PB, Johnson MA (1981) Incidence and location of accessory spleens. N Engl J Med 304:1111","journal-title":"N Engl J Med"},{"key":"12924_CR3","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1093\/ajcp\/32.2.165","volume":"32","author":"B Halpert","year":"1959","unstructured":"Halpert B, Gyorkey F (1959) Lesions observed in accessory spleens of 311 patients. Am J Clin Pathol 32:165\u2013168","journal-title":"Am J Clin Pathol"},{"key":"12924_CR4","doi-asserted-by":"publisher","first-page":"1653","DOI":"10.2214\/ajr.183.6.01831653","volume":"183","author":"KJ Mortel\u00e9","year":"2004","unstructured":"Mortel\u00e9 KJ, Mortel\u00e9 B, Silverman SG (2004) CT features of the accessory spleen. Am J Roentgenol 183:1653\u20131657","journal-title":"Am J Roentgenol"},{"key":"12924_CR5","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/0046-8177(89)90024-5","volume":"20","author":"ML Landry","year":"1989","unstructured":"Landry ML, Sarma DP (1989) Accessory spleen in the head of the pancreas. Hum Pathol 20:497","journal-title":"Hum Pathol"},{"key":"12924_CR6","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1590\/S0004-28032013000100003","volume":"50","author":"JC Ardengh","year":"2013","unstructured":"Ardengh JC, Lopes CV, Kemp R, Lima-Filho ER, Venco F, Santos JS (2013) Pancreatic splenosis mimicking neuroendocrine tumors: microhistological diagnosis by endoscopic ultrasound guided fine needle aspiration. Arq Gastroenterol 50:10\u201314","journal-title":"Arq Gastroenterol"},{"key":"12924_CR7","doi-asserted-by":"publisher","first-page":"162","DOI":"10.3348\/kjr.2008.9.2.162","volume":"9","author":"SH Kim","year":"2008","unstructured":"Kim SH, Lee JM, Han JK et al (2008) Intrapancreatic accessory spleen: findings on MR imaging, CT, US and scintigraphy, and the pathologic analysis. Korean J Radiol 9:162\u2013174","journal-title":"Korean J Radiol"},{"key":"12924_CR8","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1007\/s00261-011-9830-x","volume":"37","author":"S Kawamoto","year":"2012","unstructured":"Kawamoto S, Johnson PT, Hall H, Cameron JL, Hruban RH, Fishman EK (2012) Intrapancreatic accessory spleen: CT appearance and differential diagnosis. Abdom imaging 37:812\u2013827","journal-title":"Abdom imaging"},{"key":"12924_CR9","doi-asserted-by":"crossref","first-page":"205846011985934","DOI":"10.1177\/2058460119859347","volume":"8","author":"M Zurek Munk-Madsen","year":"2019","unstructured":"Zurek Munk-Madsen M, Zakarian K, Sandor Oturai P et al (2019) Intrapancreatic accessory spleen mimicking malignant tumor: three case reports. Acta Radiol open 8:2058460119859347","journal-title":"Acta Radiol open"},{"key":"12924_CR10","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1016\/j.amjsurg.2016.11.030","volume":"213","author":"N Bhutiani","year":"2017","unstructured":"Bhutiani N, Egger ME, Doughtie CA et al (2017) Intrapancreatic accessory spleen (IPAS): a single-institution experience and review of the literature. Am J Surg 213:816\u2013820","journal-title":"Am J Surg"},{"key":"12924_CR11","doi-asserted-by":"publisher","first-page":"1727","DOI":"10.1093\/annonc\/mdn351","volume":"19","author":"TR Halfdanarson","year":"2008","unstructured":"Halfdanarson TR, Rabe KG, Rubin J, Petersen GM (2008) Pancreatic neuroendocrine tumors (PNETs): incidence, prognosis and recent trend toward improved survival. Ann Oncol 19:1727\u20131733","journal-title":"Ann Oncol"},{"key":"12924_CR12","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1159\/000080248","volume":"4","author":"F Minni","year":"2004","unstructured":"Minni F, Casadei R, Perenze B et al (2004) Pancreatic metastases: observations of three cases and review of the literature. Pancreatology 4:509\u2013520","journal-title":"Pancreatology"},{"key":"12924_CR13","first-page":"26","volume":"6","author":"S Ninan","year":"2005","unstructured":"Ninan S, Jain PK, Paul A, Menon KV (2005) Synchronous pancreatic metastases from asymptomatic renal cell carcinoma. JOP 6:26\u201328","journal-title":"JOP"},{"key":"12924_CR14","doi-asserted-by":"crossref","unstructured":"Jang KM, Kim SH, Lee SJ, Park MJ, Lee MH, Choi D (2013) Differentiation of an intrapancreatic accessory spleen from a small (<3-cm) solid pancreatic tumor: value of diffusion-weighted MR imaging. Radiology 266:159\u2013167","DOI":"10.1148\/radiol.12112765"},{"key":"12924_CR15","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1097\/RCT.0000000000000127","volume":"38","author":"SF Coquia","year":"2014","unstructured":"Coquia SF, Kawamoto S, Zaheer A et al (2014) Intrapancreatic accessory spleen: possibilities of computed tomography in differentiation from nonfunctioning pancreatic neuroendocrine tumor. J Comput Assist Tomogr 38:874\u2013878","journal-title":"J Comput Assist Tomogr"},{"key":"12924_CR16","doi-asserted-by":"publisher","first-page":"1887","DOI":"10.1007\/s00330-006-0193-6","volume":"16","author":"SH Kim","year":"2006","unstructured":"Kim SH, Lee JM, Han JK et al (2006) MDCT and superparamagnetic iron oxide (SPIO)-enhanced MR findings of intrapancreatic accessory spleen in seven patients. Eur Radiol 16:1887\u20131897","journal-title":"Eur Radiol"},{"key":"12924_CR17","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1177\/0284185113513760","volume":"55","author":"BK Kang","year":"2014","unstructured":"Kang BK, Kim JH, Byun JH et al (2014) Diffusion-weighted MRI: usefulness for differentiating intrapancreatic accessory spleen and small hypervascular neuroendocrine tumor of the pancreas. Acta Radiol 55:1157\u20131165","journal-title":"Acta Radiol"},{"key":"12924_CR18","doi-asserted-by":"publisher","first-page":"1560","DOI":"10.1007\/s00330-017-5122-3","volume":"28","author":"A Pandey","year":"2018","unstructured":"Pandey A, Pandey P, Ghasabeh MA et al (2018) Accuracy of apparent diffusion coefficient in differentiating pancreatic neuroendocrine tumour from intrapancreatic accessory spleen. Eur Radiol 28:1560\u20131567","journal-title":"Eur Radiol"},{"key":"12924_CR19","doi-asserted-by":"publisher","first-page":"3325","DOI":"10.1007\/s00261-019-02189-8","volume":"44","author":"K Ishigami","year":"2019","unstructured":"Ishigami K, Nishie A, Nakayama T et al (2019) Superparamagnetic iron-oxide-enhanced diffusion-weighted magnetic resonance imaging for the diagnosis of intrapancreatic accessory spleen. Abdom Radiol (N Y) 44:3325\u20133335","journal-title":"Abdom Radiol (N Y)"},{"key":"12924_CR20","doi-asserted-by":"publisher","first-page":"2003","DOI":"10.1007\/s00261-020-02883-y","volume":"46","author":"MR Muehler","year":"2021","unstructured":"Muehler MR, Rendell VR, Bergmann LL, Winslow ER, Reeder SB (2021) Ferumoxytol-enhanced MR imaging for differentiating intrapancreatic splenules from other tumors. Abdom Radiol (N Y) 46:2003\u20132013","journal-title":"Abdom Radiol (N Y)"},{"key":"12924_CR21","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.4251\/wjgo.v15.i6.1051","volume":"15","author":"S Ren","year":"2023","unstructured":"Ren S, Guo K, Li Y, Cao YY, Wang ZQ, Tian Y (2023) Diagnostic accuracy of apparent diffusion coefficient to differentiate intrapancreatic accessory spleen from pancreatic neuroendocrine tumors. World J Gastrointest Oncol 15:1051\u20131061","journal-title":"World J Gastrointest Oncol"},{"key":"12924_CR22","first-page":"494","volume":"38","author":"T Ota","year":"1997","unstructured":"Ota T, Tei M, Yoshioka A et al (1997) Intrapancreatic accessory spleen diagnosed by technetium-99m heat-damaged red blood cell SPECT. J Nucl Med 38:494\u2013495","journal-title":"J Nucl Med"},{"key":"12924_CR23","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1007\/s00330-019-06337-y","volume":"30","author":"Y Nagayama","year":"2020","unstructured":"Nagayama Y, Tanoue S, Inoue T et al (2020) Dual-layer spectral CT improves image quality of multiphasic pancreas CT in patients with pancreatic ductal adenocarcinoma. Eur Radiol 30:394\u2013403","journal-title":"Eur Radiol"},{"key":"12924_CR24","doi-asserted-by":"publisher","first-page":"1352","DOI":"10.1097\/MPA.0000000000002207","volume":"51","author":"Y Fujisaki","year":"2022","unstructured":"Fujisaki Y, Fukukura Y, Kumagae Y et al (2022) Value of dual-energy computed tomography for detecting small pancreatic ductal adenocarcinoma. Pancreas 51:1352\u20131358","journal-title":"Pancreas"},{"key":"12924_CR25","doi-asserted-by":"publisher","first-page":"1679","DOI":"10.1007\/s00330-019-06517-w","volume":"30","author":"Y Fukukura","year":"2020","unstructured":"Fukukura Y, Kumagae Y, Higashi R et al (2020) Extracellular volume fraction determined by equilibrium contrast-enhanced dual-energy CT as a prognostic factor in patients with stage IV pancreatic ductal adenocarcinoma. Eur Radiol 30:1679\u20131689","journal-title":"Eur Radiol"},{"key":"12924_CR26","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2023.110756","volume":"162","author":"N Fujita","year":"2023","unstructured":"Fujita N, Ushijima Y, Itoyama M et al (2023) Extracellular volume fraction determined by dual-layer spectral detector CT: Possible role in predicting the efficacy of preoperative neoadjuvant chemotherapy in pancreatic ductal adenocarcinoma. Eur J Radiol 162:110756","journal-title":"Eur J Radiol"},{"key":"12924_CR27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2021.109944","volume":"143","author":"RM Mathy","year":"2021","unstructured":"Mathy RM, Fritz F, Mayer P et al (2021) Iodine concentration and tissue attenuation in dual-energy contrast-enhanced CT as a potential quantitative parameter in early detection of local pancreatic carcinoma recurrence after surgical resection. Eur J Radiol 143:109944","journal-title":"Eur J Radiol"},{"key":"12924_CR28","doi-asserted-by":"publisher","first-page":"999","DOI":"10.2214\/AJR.21.27017","volume":"218","author":"Y Wang","year":"2022","unstructured":"Wang Y, Hu X, Shi S et al (2022) Utility of quantitative metrics from dual-layer spectral-detector CT for differentiation of pancreatic neuroendocrine tumor and neuroendocrine carcinoma. AJR Am J Roentgenol 218:999\u20131009","journal-title":"AJR Am J Roentgenol"},{"key":"12924_CR29","doi-asserted-by":"publisher","first-page":"838","DOI":"10.2214\/AJR.22.28640","volume":"220","author":"K Si","year":"2023","unstructured":"Si K, Wu H, Yang M et al (2023) Utility of dark-blood dual-energy CT images for predicting vascular involvement and R0 resection in patients with pancreatic cancer. AJR Am J Roentgenol 220:838\u2013848","journal-title":"AJR Am J Roentgenol"},{"key":"12924_CR30","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.2214\/AJR.18.19791","volume":"211","author":"Y Noda","year":"2018","unstructured":"Noda Y, Goshima S, Miyoshi T et al (2018) Assessing chemotherapeutic response in pancreatic ductal adenocarcinoma: histogram analysis of iodine concentration and CT number in single-source dual-energy CT. AJR Am J Roentgenol 211:1221\u20131226","journal-title":"AJR Am J Roentgenol"},{"key":"12924_CR31","doi-asserted-by":"publisher","first-page":"571","DOI":"10.2214\/AJR.17.19170","volume":"211","author":"BN Patel","year":"2018","unstructured":"Patel BN, Rosenberg M, Vernuccio F et al (2018) Characterization of small incidental indeterminate hypoattenuating hepatic lesions: added value of single-phase contrast-enhanced dual-energy CT material attenuation analysis. AJR Am J Roentgenol 211:571\u2013579","journal-title":"AJR Am J Roentgenol"},{"key":"12924_CR32","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1148\/radiol.2020192227","volume":"296","author":"Y Nagayama","year":"2020","unstructured":"Nagayama Y, Inoue T, Oda S et al (2020) Adrenal adenomas versus metastases: diagnostic performance of dual-energy spectral CT virtual noncontrast imaging and iodine maps. Radiology 296:324\u2013332","journal-title":"Radiology"},{"key":"12924_CR33","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1186\/s13244-024-01752-2","volume":"15","author":"H Xia","year":"2024","unstructured":"Xia H, Chen Y, Cao A et al (2024) Differentiating between benign and malignant breast lesions using dual-energy CT-based model: development and validation. Insights imaging 15:173","journal-title":"Insights imaging"},{"key":"12924_CR34","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1148\/radiol.220919","volume":"306","author":"S Lennartz","year":"2023","unstructured":"Lennartz S, Schoenbeck D, Kr\u00f6ger JR, Borggrefe J, Henning Niehoff J (2023) Photon-counting CT material decomposition: initial experience in assessing adrenal adenoma. Radiology 306:202\u2013204","journal-title":"Radiology"},{"key":"12924_CR35","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1177\/0284185118788895","volume":"60","author":"X Lin","year":"2019","unstructured":"Lin X, Xu L, Wu A, Guo C, Chen X, Wang Z (2019) Differentiation of intrapancreatic accessory spleen from small hypervascular neuroendocrine tumor of the pancreas: textural analysis on contrast-enhanced computed tomography. Acta Radiol 60:553\u2013560","journal-title":"Acta Radiol"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12924-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-026-12924-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12924-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:02:58Z","timestamp":1790982178000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-026-12924-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,2]]},"references-count":35,"alternative-id":["12924"],"URL":"https:\/\/doi.org\/10.1007\/s00330-026-12924-7","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,2]]},"assertion":[{"value":"22 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 August 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 August 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 October 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The scientific guarantor of this publication is Toshinori Hirai.","order":1,"name":"Ethics","label":"Guarantor","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Toshinori Hirai has received research support from Philips Healthcare. Philips Healthcare had no control over the interpretation, writing, or publication of this work.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"No complex statistical methods were necessary for this paper.","order":3,"name":"Ethics","label":"Statistics and biometry","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Written informed consent was waived by the Institutional Review Board.","order":4,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Institutional Review Board approval was obtained.","order":5,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"No study subjects or cohorts have been previously reported.","order":6,"name":"Ethics","label":"Study subjects or cohorts overlap","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"order":7,"name":"Ethics","label":"Methodology","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}}]}}