Endometrial Injury and Preservation after Magnetic Resonance-guided Focused Ultrasound Ablation of Uterine Fibroids / 中国医学科学院学报

Objective To explore the risk factors for incident endometrial injury and 3-month endometrial injury after magnetic resonance-guided focused ultrasound(MRgFUS)ablation of uterine fibroids(UF). Methods UF patients who were diagnosed in Peking Union Medical College Hospital and underwent MRgFUS ablation in Amcare Women's and Children's Hospital from August 2016 to October 2020 were retrospectively enrolled in this study.Clinical data of 66 UF patients were collected and compared between endometrial injury group and non-injury group.Stepwise regression was employed to determine the risk factors for the incident endometrial injury and 3-month endometrial injury.Multivariate logistic regression analysis was performed to explore the relationship of endometrial injury with age,pre-ablation tumor size,multiple UF,International Federation of Gynecology and Obstetrics(FIGO)classification,T2WI signal intensity,and treatment time.Results In terms of incident endometrial injury,the 66 patients included 41(62.1%)cases with no injury,4 cases(6.1%) with grade 1 injury,5 cases(7.6%)with grade 2 injury,and 16 cases(24.2%)with grade 3 injury.In terms of 3-month endometrial injury,the 66 patients included 49 cases(74.2%)with no injury,5 cases(7.6%)with grade 1 injury,2 cases(3.0%)with grade 2 injury,and 10 cases(15.2%)with grade 3 injury.Stepwise regression analysis indicated that FIGO classification was significantly associated with incident endometrial injury(

Predictive Value of Texture Analysis in the Treatment of Magnetic Resonance-guided Focused Ultrasound Surgery for Symptomatic Uterine Fibroids / 中国医学科学院学报

Objective To evaluate the predictive value of texture analysis in the treatment of magnetic resonance-guided focused ultrasound surgery(MRgFUS)for symptomatic uterine fibroids.Methods Totally 16 patients with symptomatic uterine fibroids who accepted MRgFUS in Peking Union Medical College Hospital from April 2010 to January 2013 were included. Enhanced magnetic resonance imaging(MRI)was performed before treatment,immediately after treatment,and during the 12-month follow-up. The TexRAD software was used to measure the texture parameters of the fibroids in T2WI sagittal images,and the texture indicators including means and standard deviations(SD),entropy,mean of positive pixels(MPP),skewness,and kurtosis were collected. The fibroid's volume and their change rates were calculated by measuring the relevant diameter of the target fibroid. The Uterine Fibroid Symptoms and Quality of Life(UFS-QOL)was used to calculate the symptom severity scores(SSS)and its change rate. The statistical difference of parameters among the groups was analyzed. The correlations between each texture parameter and the therapeutic outcome of the fibroids were analyzed respectively.Results The average volume for fibroids before treatment was(96.5±84.9)cm ,which was reduced to(55.1±71.0)cm after treatment for 12 months,and the volume change rate(εV%)was(49±20)%. The standardized SSS score before treatment was(34.18±15.29)scores,decreased to(17.78±11.84)scores 12 months after treatment,with a change rate of(45±32)%,and the non-perfused volume ratio(NPV%)was(62±20)%. There were significant differences among the parameters mean,SD,entropy,and MPP among three groups(all P<0.05),and the changes of them were regular,all of which showed a significant decrease immediately after treatment and a significant increase 12 months after treatment,and the increase degree was higher than the preoperative level. SD(SSF2:r=0.503,P=0.047;SSF4:r=0.529,P=0.035;SSF6:r=0.519,P=0.039)and entropy(SSF2:r=0.527,P=0.036;SSF4:r=0.517,P=0.040;SSF6:r=0.495,P=0.050)of the after-treatment group moderately associated with the εV%. Entropy of the before-treatment group was moderately associated with NPV%(SSF2:r=0.507,P=0.045;SSF4:r=0.543,P=0.030;SSF6:r=0.548,P=0.028).Conclusion There is a certain correlation between the changes of MRI texture parameters before and after treatment and the effect of MRgFUS in the treatment of uterine fibroids,and texture analysis may have certain value in the predicting the effect of MRgFUS on uterine fibroids.

Application of single-bolus dual-source dual-energy CT urography in upper tract opacification and diagnostic performance for painless hematuria / 中国医学科学院学报

<p><b>OBJECTIVE</b>To assess the upper urinary tract opacification and the diagnostic performance of one-bolus dual-source dual-energy CT urography (CTU) for painless hematuria.</p><p><b>METHODS</b>Totally 205 patients who underwent dual-source dual-energy CTU for painless hematuria were enrolled in this study. CTU included true non-enhanced phase, dual-energy mode nephrographic phase, and FLASH mode excretory phase imaging of the urinary tract. Two radiologists independently evaluated the degree of upper urinary tract opacification. Prospective interpretations using true non-enhanced, nephrographic and excretory phase imaging for hematuria were recorded, as well as retrospective diagnosis using virtual non-enhanced, nephrographic and excretory phase imaging. The standard of reference included all available clinical, imaging, laboratory and follow-up data for up to 36 months after CTU exam. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy were calculated. Receiver-operating characteristic (ROC) analysis was undertaken and the area under the curve (AUC) calculated. The prospective and retrospective diagnostic performance for hematuria and the radiation dose of two CTU protocols were compared.</p><p><b>RESULTS</b>It was found that 87.8% and 86.8% of segments were at least 50% opacified, respectively. The sensitivity, specificity, PPV, NPV and accuracy for hematuria for prospective interpretation were 95.2%, 91.9%, 98.2%, 81.0% and 94.6%, respectively. Comparable figures for retrospective diagnosis were 98.8%, 91.9%,98.2%, 94.4% and 97.6%. The AUC for prospective and retrospective diagnosis were 0.931±0.027 and 0.940±0.026, respectively (z=1.425, Bonferroni-corrected P>0.05). The radiation dose of the CTU protocol using in retrospective diagnosis[(12.732±3.485)mSv] was significantly lower than that of prospective diagnosis [(17.002±4.013)mSv] (P<0.05), with dose reduction of (32.74±8.92)%.</p><p><b>CONCLUSION</b>One-bolus two-phase dual-source dual-energy CT urography provides at least 50% opacification of upper urinary tract segments and has high diagnostic performance for painless hematuria with relatively low radiation dose.</p>

Computed tomographic angiography for evaluation of the relationship between coronary artery stenosis and head and neck artery stenosis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the relationship between coronary artery stenosis and internal carotid artery, vertebral and basilar artery stenosis using computed tomographic angiography.</p><p><b>METHODS</b>The imaging and clinical data of 84 patients who underwent coronary, head and cervical computed tomographic angiography in our hospital between September 2008 and June 2010 were retrospectively analyzed. Segment stenosis scoring was performed to quantify the degree of stenosis of coronary arteries. The relationship between the segment stenosis scoring and the degree of stenosis for internal carotid artery, vertebral and basilar artery was analyzed.</p><p><b>RESULT</b>The coronary segment stenosis scores were significantly correlated with the degree of stenosis for internal carotid artery, vertebral and basilar artery (r=0.450 and 0.475,P<0.05) .</p><p><b>CONCLUSION</b>The degree of the stenosis of coronary artery is associated with the stenosis of internal carotid artery, vertebral and basilar artery, which can be confirmed by computed tomographic angiography."</p>

Dual-energy computed tomographic angiography of head and neck arteries with different contrast material doses in second generation dual-source computed tomography system / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the feasibility of a dual-energy computed tomographic angiography (DECTA) protocol using test-bolus injection with reduction of contrast material (CM) dose in second generation dual-source CT system.</p><p><b>METHODS</b>Totally 57 consecutive patients underwent CT angiography scan covering the cervical and cerebral arteries. CT was performed with second generation dual-source CT system. The time to peak (T) using a test-bolus injection was calculated. The patients were divided into three groups (A, B, and C) with different CM doses (40, 45, and 50 ml) and different delay time points [ (T+1) , (T+1) , and (T+2) s] . All the patients were followed by a 48 ml saline flush. Arterial enhancements were quantified by measuring attenuation values of the aortic arch, bifurcation of common carotid artery, contralateral internal jugular vein of the CM injection, superior vein cava, proximal middle cerebral artery, basilar artery, and straight sinus on source images. Visualizations of intracranial artery and ipsilateral venous effect of the CM injection were rated on a four-point grading scale on CTA images for qualitative assessment.</p><p><b>RESULTS</b>Although the attenuation of internal jugular vein and straight sinus were significantly lower in group A than in groups B and C (P<0.05) , the attenuation of aortic arch, superior vein cava, common carotid artery, middle cerebral artery, and basilar artery vessels showed no significant differences among these three groups. The scores of the visualizations of intracranial artery and ipsilateral venous effect of the CM injection were also not significantly different among these three groups.</p><p><b>CONCLUSION</b>Based on the delay time calculated by a test-bolus injection, a reduced-dose contrast material may provide an equal degree of arterial attenuation and a lower attenuation of vein for dual-energy CTA covering the craniocervical region in second generation dual-source CT system.</p>

Application of second generation dual-source computed tomography dual-energy scan mode in detecting pancreatic adenocarcinoma / 中国医学科学院学报

<p><b>OBJECTIVE</b>To analyze the clinical value of multiple sequences derived from dual-source computed tomography (DSCT) dual-energy scan mode in detecting pancreatic adenocarcinoma.</p><p><b>METHODS</b>Totally 23 patients with clinically or pathologically diagnosed pancreatic cancer were enrolled in this retrospective study. DSCT (Definition Flash) was used and dual-energy scan mode was used in their pancreatic parenchyma phase scan (100kVp/230mAs and Sn140kVp/178mAs) . Mono-energetic 60kev, mono-energetic 80kev, mono-energetic 100kev, mono-energetic 120kev, linear blend image, non-linear blend image, and iodine map were acquired. pancreatic parenchyma-tumor CT value difference, ratio of tumor to pancreatic parenchyma, and pancreatic parenchyma-tumor contrast to noise ratio were calculated. One-way ANOVA was used for the comparison of diagnostic values of the above eight different dual-energy derived sequences for pancreatic cancer.</p><p><b>RESULTS</b>The pancreatic parenchyma-tumor CT value difference, ratio of tumor to pancreatic parenchyma, and pancreatic parenchyma-tumor contrast to noise ratio were significantly different among eight sequences (P<0.05) . Mono-energetic 60kev image showed the largest parenchyma-tumor CT value [ (77.53 ± 23.42) HU] , and iodine map showed the lowest tumor/parenchyma enhancement ratio (0.39?0.12) and the largest contrast to noise ratio (4.08 ± 1.46) .</p><p><b>CONCLUSIONS</b>Multiple sequences can be derived from dual-energy scan mode with DSCT via multiple post-processing methods. Integration of these sequences may further improve the sensitivity of the multislice spiral CT in the diagnosis of pancreatic cancer.</p>

Clinical application of dual-source computed tomographic urography using dual-energy virtual non enhanced computed tomography / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the clinical feasibility of dual-source computed tomographic urography using dual-energy virtual non-enhanced CT.</p><p><b>METHODS</b>Totally 240 patients received dual-source CT, which included true non-enhanced CT (TNCT) , nephrographic phase scanning with dual-energy mode (100kVp/230mAs and Sn140kVp/178mAs) , and excretory phase scanning. A contrast bolus injection of 100 ml (370 mgI/ml) contrast agent was applied (4.5ml/s) , followed by 100ml normal saline (4.5ml/s) . Virtual non-enhanced CT (VNCT) image sets were reformatted from 'Liver VNC ' software. The mean CT number, noise, signal to noise ratio (SNR) , image quality, and radiation dose were compared between TNCT and VNCT image sets.</p><p><b>RESULTS</b>There was no significant difference in mean CT numbers of all organs (P>0.05) . However, VNCT images had significantly lower noise and higher SNR than TNCT images (both P<0.05) . Image quality of VNCT was lower than that of TNCT without significant difference (P>0.05) . Radiation dose of nephrographic phase with dual-energy mode was significantly higher than that of TNCT and excretory phase scanning (P<0.05) .</p><p><b>CONCLUSION</b>Dual-energy VNCT requires less radiation dose and therefore has a potential to replace TNCT in the dual-source CT urography.</p>

Features of eight segments of liver perfusion with the second generation dual-source computed tomography / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the features of eight segments of liver perfusion with the second generation dual-source computed tomography (DSCT) .</p><p><b>METHODS</b>Totally 15 patients with pancreatic endocrine diseases underwent abdominal CT perfusion with the second generation DSCT. The liver perfusion images were then transferred to workstation, and perfusion parameters were calculated, and then the artery liver perfusion (ALp) , portal-vein liver perfusion (pVp) , and hepatic perfusion index (HpI) of the eight hepatic segments were calculated.</p><p><b>RESULTS</b>ALp was significantly different between segments 3, 4 and segments 5-8 (P<0.05) . pVp was significantly different between segments 2 and segments 6, 7 (P<0.05) . pVp and HpI were significantly different between segment 3 and segments 5-8 (P<0.05,P<0.01) .</p><p><b>CONCLUSIONS</b>The second generation DSCT can be used to evaluate the perfusion conditions in all eight hepatic segments. The perfusion differs among eight segments of liver, which may be related with the anatomy of the liver vessels and the position of DSCT scanning. Its clinical significance needs further research.</p>