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Objective To explore the role of CT scan for the diagnosis of lung metastasis in stage Ⅲ gestational trophoblastic neoplasia (GTN).Methods To figure out the role of CT scan for lung metastasis in GTN initial diagnosis,treatment and follow-up,93 GTN patients with lung metastasis from January,2015 to December,2016 were retrospectively analyzed in Obstetrics and Gynecology Hospital of Fudan University.Results (1) Among 93 GTN patients with lung metastasis,70 patients with the International Federation of Gynecology and Obstetrics (FIGO) score ≤6 were defined as low risk GTN and 23 patients score score ≥7 were defined as high risk GTN.Forty nine patients had negative chest X-ray findings and 39 cases with pulmonary lesions were identified both by chest X-ray compared to CT scan.Five cases were excluded due to no consensus could make for the results of chest X-ray.The true positive rate of chest X-ray for lung metastasis were 41％ (29/70) in low risk GTN and 43％ (10/23) in high risk GTN patients without statistical difference (x2=0.090,P=0.925).For those patients with positive chest CT scan and negative chest X-ray finding,pulmonary lesions in 32 (65％,32/49) cases were blocked by heart,chest wall or diaphragm in chest X-ray.Seventeen (35％,17/49) patients with lung lesions less than 5 mm had negative chest X-ray results due to the lower sensitivity compared to CT scan.(2) In 88 patients with stage Ⅲ,78 patients had successful initial treatment,but 4 of them were recurrence in twelve months follow-up.Ten patients were chemotherapy resistance for the initial treatment.The initial chemotherapy remission rate in low risk GTN patients was higher than that in high risk ones (x2=4.911,P=0.027).In 49 cases with negative chest X-ray,there was no correlation with the rate of remission,chemotherapy resistance and recurrence in stage Ⅲ patients (P＞0.05).(3) For those patients who had poorly response to initial chemotherapy,the diameters of lesions in lung were unchanged or increased during the treatment,form (5.1±4.1) mm to (7.4±2.8) mm.The pulmonary lesions were continuously shrunk from (7.8 ± 5.3) mm to (4.7 ± 4.4) mm for those patients with complete and partial remission including the recurrent GTN patients (Z=-2.713,P=0.007).Conclusions Patients with GTN in stage Ⅲ have down staging if only use chest X-ray for imaging at the initial diagnosis.Chest CT scan is recommended for primary imaging evaluation of FIGO staging in qualified medical organization.For those patients with persistent abnormal serum hCG level and negative chest X-ray,chest CT scan is strongly recommended to identify the persist or resistant lung lesions and follow up.
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Objective To investigate the value of the apparent diffusion coefficient (ADC)measurement in assessment of tumor grade and myometrial invasion of endometrial carcinoma (EC).Methods 80 EC patients and 28 cervical cancer patients with normal endometrium were studied retrospectively.1.5T conventional MRI and DWI (b=0,1 000 s/mm2)were performed,and ADC values were calculated by two radiologists.Statistical analyses were performed by using SPSS 19.0 and Medcalc software.Results The mean ADC values (×10-3mm2/s)were 0.851±0.131,0.752±0.099,0.681±0.089 for G1,G2 and G3 EC,respectively.Significant statistical differences were achieved for the three groups (G1 vs G2:P=0.005;G2 vs G3:P=0.03;G1 vs G3:P< 0.000 1).For the prediction of G3,the area under the curve (AUC)of 0.851 and the cut-off value of ≤0.742×10-3mm2/s were identified,with the sensitivity, specificity and accuracy of 88.24%,76.19% and 85%,respectively.Conclusion There are significant statistical differences between histologic grades of EC.ADC measurement may have the potential to select G3 EC patients.
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Objective To investigate the ability of proton magnetic resonance spectroscopy (1H-MRS) for differentiating benign from malignant solid adnexal tumors. Methods One-hundred and six patients (114 tumors) with surgically and histologically proven solid adnexal tumors (44 benign, 70 malignant) underwent conventional MR imaging and 1H-MRS. Single-voxel spectroscopy was performed using the point resolved spectroscopy localization technique with a voxel size of 2.0 cm × 2.0 cm × 2.0 cm. Resonance peak integrals of choline (Cho), N-acetyl aspartate (NAA), creatine (Cr), lactate (Lac), and lipid (Lip) were analyzed and the Cho/Cr, NAA/Cr, Lac/Cr and Lip/Cr ratios were recorded and compared between benign and malignant tumors using independent two-sample t test. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance of Cho/Cr ratio for differentiating benign from malignant tumors. Results A Cho peak was detected in all 114 tumors, NAA peak in 112 tumors (43 benign and 69 malignant), Lip peak in 70 tumors (21 benign and 49 malignant), and Lac peak in 16 tumors (7 benign and 9 malignant). The Cho/Cr and Lip/Cr ratios were 4.8±2.5, 6.4±4.0 in benign versus 9.6 ± 3.3, 10.5 ± 4.6 in malignant solid adnexal tumors, respectively, with a statistically significant difference (t values were-8.826 and-2.915,P malignant solid adnexal tumors, with no statistically significant difference (t=-1.523,P>0.05). When the Cho/Cr threshold was 7.2 for differentiating between benign and malignant tumors, the sensitivity, specificity, accuracy were 80.0%(56/70),88.6%(39/44) and 83.3%(95/114) respectively. Conclusions The 1H-MRS patterns of benign and malignant solid adnexal tumors differ. The Cho/Cr ratio can help clinicians differentiate benign from malignant tumors.
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Objective To establish a stable and feasible animal model of acute cerebral infarction,and to evaluate it with functional magnetic resonance imaging and pathology.Methods Twenty-five S-D rats were randomly divided into five groups,and there were 5 rats in each group.Rats in group A were sham-operated for control study.Unilateral middle cerebral artery occlusion(MCAO) was performed with improved thread in group B,C,D,E and were enrolled for MRI and MRS study at 3,6,12,24 hours after MCAO.All rats were examined by 1-hydrogen magnetic resonance spectroscopy(~1H MRS).Two or three rats in each group were sacrificed for 2,3,5-triphenyltetrazolium chloride(TTC) staining of the brain and two rats for pathological examination after MRS.Results Rats in group A showed no change in brain on ~1 H MRS or pathological study.~1H MRS of the rat brains after right MCAO showed a decrease of N-acetyl-aspartate(NAA),an increase of Lactate(Lac) in all groups.There was no significant change of Choline(Cho) and Creatine(Cr) peaks onrats in group B,C,D.The peaks of Cho and Cr were slightly dropped in group E.Conclusion The acute regional cerebral ischemic model in rats made by our approach is stable and reproducible,and it is suitable for evaluation and study with functional magnetic resonancespectroscopy accurately and sensitively.